Swim School Call Back/Interest List Form Swim School Call-back List Which booking period are you interested in?*I'd like a phone call back now please.Term 1, Jan-MarTerm 2, Apr-JunTerm 3, Jul-SeptTerm 4, Oct-DecNoneWhich school holiday intensives period are you interested in?*I'd like a phone call back now please.Jan Holiday IntensivesMar/April Holiday IntensivesJune/July Holiday IntensivesSept/Oct Holiday IntensivesNoneWhich pool would you like to swim at?*Mont Albert onlyRingwood onlyI could swim at either Mont Albert or RingwoodStudent #1:Name* First Last Date of Birth* DD MM YYYY Swim Level (if known)Preferred Days/TimesStudent #2:Name First Last Date of Birth DD MM YYYY Swim Level (if known)Preferred Days/TimesStudent #3:Name First Last Date of Birth DD MM YYYY Swim Level (if known)Preferred Days/TimesContact Person:Name* First Last Preferred Phone Number*Secondary Phone NumberEmail* Enter Email Confirm Email Extra Comments:Is there anything else you would like us to know about these students? (eg. Have they done other swimming classes before? Are there any special needs? etc.)How did you first hear about Healthways Swim School?*