Swimming Intensives Online Enrolment Form Swimming Intensives Online Enrolment Form If you would like to enrol in upcoming swimming intensive classes, you can register your enrolment here. You will be asked to make payment which will be put towards your class. According to the class preferences you outline, your class details will be confirmed via email. If a suitable class time cannot be found your payment is fully refundable. Please note that a secure online payment gateway is included in this form. You will be asked to pay by credit card at the end. (Note: Secure online payment is via eWay, Australia's leading payment gateway. All communication between this form and eWay is encrypted using an SSL certificate. Healthways does not store your credit card information.) Student’s Details:Name* First Last Date of Birth* DD MM YYYY Have you swum at Healthways before?*YesNoGreat! We'll have your last skill level grading on file and will be able to place you in a class using that. If you think that isn't going to be appropriate, let us know by writing any comments here.Are you a beginner?*YesNo, I have done some classes elsewhereGreat. You'll start off in a beginner class for your age group and work through the skill levels from there.Great. So that we know what skill level to start you off in, let us know about what skills you can do by writing any comments here. Thanks.Booking Details:Please select your preferred pool location:*Mont Albert North - Healthways Recreation Centre, 1-11 Arcade Road, Mont Albert North 3129Ringwood - Healthways Aquatic Centre, 108-110 New Street, Ringwood 3134EitherDo you want Group Classes or Private Lessons?*Group Classes (Max 4 students per class)Private Lessons (1:1)Private Lessons (1:2)What program do you want to enrol in?*Week 1 ONLY (Mon 04/01/21-Fri 08/01/21)Week 2 ONLY (Mon 11/01/21-Fri 15/01/21)Week 3 ONLY (Mon 18/01/21-Fri 22/01/21)Week 1 & Week 2 (Mon 04/01/21-Fri 08/01/21, Mon 11/01/21-Fri 15/01/21)Week 2 & Week 3 (Mon 11/01/21-Fri 15/01/21, Mon 18/01/21-Fri 22/01/21)Week 1 & Week 3 (Mon 04/01/21-Fri 08/01/21, Mon 18/01/21-Fri 22/01/21)ALL Weeks 1, Week 2 & Week 3 (Mon 04/01/21-Fri 08/01/21, Mon 11/01/21-Fri 15/01/21, Mon 18/01/21-Fri 22/01/21)What program do you want to enrol in?*Week 1 ONLY (Mon 04/01/21-Fri 08/01/21)Week 2 ONLY (Mon 11/01/21-Fri 15/01/21)Week 3 ONLY (Mon 18/01/21-Fri 22/01/21)Week 1 & Week 2 (Mon 04/01/21-Fri 08/01/21, Mon 11/01/21-Fri 15/01/21)Week 2 & Week 3 (Mon 11/01/21-Fri 15/01/21, Mon 18/01/21-Fri 22/01/21)Week 1 & Week 3 (Mon 04/01/21-Fri 08/01/21, Mon 18/01/21-Fri 22/01/21)ALL Weeks 1, Week 2 & Week 3 (Mon 04/01/21-Fri 08/01/21, Mon 11/01/21-Fri 15/01/21, Mon 18/01/21-Fri 22/01/21)Other: Private lessons can be booked individually. Select this option if you don't want to do a full week of lessons.What program do you want to enrol in?*Week 1 ONLY (Mon 04/01/21-Fri 08/01/21)Week 2 ONLY (Mon 11/01/21-Fri 15/01/21)Week 3 ONLY (Mon 18/01/21-Fri 22/01/21)Week 1 & Week 2 (Mon 04/01/21-Fri 08/01/21, Mon 11/01/21-Fri 15/01/21)Week 2 & Week 3 (Mon 11/01/21-Fri 15/01/21, Mon 18/01/21-Fri 22/01/21)Week 1 & Week 3 (Mon 04/01/21-Fri 08/01/21, Mon 18/01/21-Fri 22/01/21)ALL Weeks 1, Week 2 & Week 3 (Mon 04/01/21-Fri 08/01/21, Mon 11/01/21-Fri 15/01/21, Mon 18/01/21-Fri 22/01/21)Other: Private lessons can be booked individually. Select this option if you don't want to do a full week of lessons.What are your day preferences for your private lessons?*Other:Is there anything else we need to know about your re-enrolment? Eg. Special needs, matching up siblings, preferred times of day, etc.NoYesPlease provide details*Total $ 0.00 Payment:Online enrolment requires a deposit which goes towards your class fees. If you are not able to be placed as requested, your deposit is fully refundable.Please enter your credit card details:*Secure payment via eWay, Australia's leading payment gateway. All communication between this form and eWay is encrypted using an SSL certificate. Healthways does not store your credit card information. DiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Expiration Date Security Code Cardholder Name Contact Details:My name is:* First Last Contact phone number:*Secondary phone number:Email:* Enter Email Confirm Email Terms and Conditions:* I accept the Swim School's Policies and Procedures. Please CLICK HERE for the 'Policies and Procedures Brochure'. BEFORE CLICKING SUBMIT...Please review your entries above and ensure they are correct. When you click 'Submit' your form will be processed.AFTER CLICKING SUBMIT...Please click 'Submit' only ONCE and look for the CONFIRMATION message. When you click 'Submit' you will see either a confirmation message or there will be parts of your form highlighted red to indicate information that is not filled in correctly. If you can still read this sentence after clicking 'Submit', you have not submitted the form correctly. Please review your form and try again. Thank you.
