Enrolment
 
  * Fields are mandatory
  * How did you hear about us?
     
  Web
  School
  Friend
  Media
   
  * My child attends:
     
  School:
  Grade:
     
  Particulars of student:
Name & Surname:Name by which child is knownDate of birth
     
  * Particulars of Father:
     
  Name:
  Surname:
  Title:
  ID number:
  Residential Address:
  Home phone number:
  Email:
  Work phone number:
  Cell:
  Occupation:
  Employer and address:
     
  * Particulars of Mother
     
  Name:
  Surname:
  Title:
  ID number:
  Residential Address:
  Home phone number:
  Email:
  Work phone number:
  Cell:
  Occupation:
  Employer and address:
     
  * Does your child have grommets or any problems relating to water?: (If yes, please give more information)
 
   
  * How would you describe your child’s ability in water at present? (specify any swimming aids that have been used):
 
   
  * Is there anything else you think we should know? (e.g. complexes, lack of confidence, physical disabilities):
 
   
  Please complete the fields below:
Doctor:Tel number:Allergies:
     
  * How many lessons will your child have per week:
     
  1 lesson per week
  2 lesson per week
   
   
 


Acknowledgement


Upon signature of this agreement and disclaimers on the enrolment form, the parties agree that they have read the contents of this agreement and that they understand it, and that they are legally and irrevocably bound to all the terms and conditions as set out in the Terms and Conditions annexure.I fully understand that the activities and exercises of the swimming programme require vigorous physical activity, hereby represent and confirm that I/the aforementioned minor child/ren’s physical condition and health permits me/him/her/them to fully participate in the swimming activities and exercises without undue risk to my/his/her/their wellbeing. Should I/my child/ren feel unwell shortly before the lesson, I undertake full responsibility of immediately withdrawing myself/him/her/them from participation in the lesson.

I acknowledge on behalf of myself/the aforementioned minor child/ren of the potential danger incidental to engaging in swimming activities, which include, but are not limited to, bodily injuries, health disorder and even possible death. I, in my personal capacity as parent/guardian for the minor child/ren/myself hereby accept those risks.
I/the aforementioned minor child/ren is voluntary participating in this program. I/the minor child/ren will not be accepted for participation in the program if the swimming instructor knows of any reason why my/his/her/their participation would be dangerous to my/his/her/their health.


I understand that Edu-Swim may take my child to a swimming activity, travelling by motor vehicle. I request, and consent to the aforementioned minor child/ren being transported by Edu-Swim to and from the swimming venue/s by a Edu-Swim representative/employee, which representative/employee will be in possession of a valid driver’s license.
I authorize the swimming instructor to obtain or perform any emergency medical assistance which they deem necessary, in the event of an accident, and I agree to be responsible for all necessary and reasonable medical expenses incurred in this regard.


I, in my personal capacity or in my capacity as parent/guardian of the minor child/ren and my or our executors, my or our heirs, my or our assigns and successors entitle, hereby indemnify and hold harmless the Edu-Swim and or any of their representatives and/or employees and/or insurers, from any claims, demands, liability, loss or damage from any cause, which I/the minor child/ren should/may suffer as a result of my/the minor child/ren’s participation in the swimming program.
I further understand and agree that my child/ren must always be supervised whenever near or in the water. I understand and agree that these lessons do not imply or make any guarantee of water safety for my infant/child/ren and that a responsible adult shall always supervise my child/ren.
I confirm that I am fully aware of the legal consequences of signing this document and declare that I am duly authorised to enter into this agreement on my/the said minor’s behalf.

   
  Please enter the date in the Text Box below
  --
   
  * I have read and understand the terms and conditions as set out above and herewith agree to the terms and conditions.
     
  I agree
   
 
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