Family Details Form

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Ages 6 month to adults
Friendly Austswim qualified teachers
All staff are First Aid and Blue Card Certificated
We cater for children with illness, disabilities or fear of water
Home based family business teaching learn to swim since 2006
optional swimming pool venues:
- Home Pool (Heated to a comfortable 32 degrees) Suitable for Learn to Swim only
- Geebung Stage School Pool

Available Swimming Programs

Please Contact Us

Child's Details:
Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Medical Information
Please specify and illness or disability e.g. asthma, diabetes, epilepsy, motor skills, muscle tone or fear of water
- Add Child
Child 2
Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Medical Information
Please specify and illness or disability e.g. asthma, diabetes, epilepsy, motor skills, muscle tone or fear of water
- Add Child
Child 3
Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Medical Information
Please specify and illness or disability e.g. asthma, diabetes, epilepsy, motor skills, muscle tone or fear of water
- Add Child
Child 4
Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Medical Information
Please specify and illness or disability e.g. asthma, diabetes, epilepsy, motor skills, muscle tone or fear of water
- Add Child
Child 5
Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Medical Information
Please specify and illness or disability e.g. asthma, diabetes, epilepsy, motor skills, muscle tone or fear of water
- Add Child
Child 6
Name*
First Last
Date of Birth*
Date Format: DD slash MM slash YYYY
Medical Information
Please specify and illness or disability e.g. asthma, diabetes, epilepsy, motor skills, muscle tone or fear of water

Parent / Guardian Details
Parent / Guardian 1*
First Last
Phone*
Parent / Guardian 2
First Last
Phone
Family Email*
Enter Email Confirm Email
Address*
Street Address City Post Code
Emergency Contact*
First Last
Please provide an emergency contact for if the parent / guardians listed above are unreachable.
Phone*

Terms and Conditions
- Full payment required 14 days from date of invoice (Ezidebit payment plan excluded).
- No Refunds will be made once classes have commenced.
- Each student is eligible for three makeup classes to be requested via the parent portal on the Sue Mickelson Website (Terms and Conditions Apply).
- Your family's email will be used for all written correspondence e.g. News letter, invoicing and general information.
- Yes I accept the above terms and conditions
Social Media Consent:
- Photos may be taken of your child in class for display purposes and and social media.
- I accept that photos may be taken of my child in class for display purposes and and social media.
- Please do not publish photos of my child on social media platforms.

Child's Details: