{"id":8792,"date":"2025-02-12T20:37:00","date_gmt":"2025-02-12T09:37:00","guid":{"rendered":"https:\/\/www.healthways.com.au\/boxhill\/?page_id=8792"},"modified":"2026-09-08T23:51:10","modified_gmt":"2026-09-08T13:51:10","slug":"baby-swim-form","status":"publish","type":"page","link":"https:\/\/www.healthways.com.au\/boxhill\/swimming-pool\/swimming-lessons\/baby-swim\/baby-swim-form\/","title":{"rendered":"Begin your BrainWaves Babies Journey (for 4-6mth olds)"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_179' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Register for your 3 FREE BrainWave Babies Sessions<\/h3>\n                            <p class='gform_description'>To help start every child on their BrainWave Journey we offer 3 Complimentary BrainWave Babies Sessions per child.  <br>\r\nSimply fill out this form, and your child with be credited with 3 BrainWave Babies Sessions.<br>\r\n(Please allow 5 business days for your free sessions to be ready to book online.  In the meantime, you can book and pay for sessions individually if you wish.)<br><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_179'  action='\/boxhill\/wp-json\/wp\/v2\/pages\/8792' data-formid='179' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_179' class='gform_fields top_label form_sublabel_below description_above validation_below'><li id=\"field_179_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><label class='gfield_label gform-field-label' ><span class='gform-field-label__text'>What is your preferred pool location?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_179_26'>\n\t\t\t<li class='gchoice gchoice_179_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='Mont Albert North Pool:  Healthways Recreation Centre, 1-11 Arcade Road, Mont Albert North 3129, Ph. 98952300'  id='choice_179_26_0'    \/>\n\t\t\t\t<label for='choice_179_26_0' id='label_179_26_0' class='gform-field-label gform-field-label--type-inline'>Mont Albert North Pool:  Healthways Recreation Centre, 1-11 Arcade Road, Mont Albert North 3129, Ph. 98952300<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_179_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='Ringwood Pool:  Healthways Aquatic Centre, 108-110 New Street, Ringwood 3134, Ph. 98795777'  id='choice_179_26_1'    \/>\n\t\t\t\t<label for='choice_179_26_1' id='label_179_26_1' class='gform-field-label gform-field-label--type-inline'>Ringwood Pool:  Healthways Aquatic Centre, 108-110 New Street, Ringwood 3134, Ph. 98795777<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_179_24\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Baby Details:<\/h2><\/li><li id=\"field_179_2\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_179_2'>\n                            <span id='input_179_2_3_container' class='name_first gform-grid-col' >\n                                                    <input type='text' name='input_2.3' id='input_179_2_3' value=''   aria-required='true'    \/>\n                                                    <label for='input_179_2_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                               <\/span>\n                            <span id='input_179_2_6_container' class='name_last gform-grid-col' >\n                                                    <input type='text' name='input_2.6' id='input_179_2_6' value=''   aria-required='true'    \/>\n                                                    <label for='input_179_2_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/li><li id=\"field_179_27\" class=\"gfield gfield--type-date gfield--input-type-datefield gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Date of Birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_179_27' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\">\n                                    <div class='gfield_date_day ginput_container ginput_container_date gform-grid-col' id='input_179_27_2_container'>\n                                        <input type='number' maxlength='2' name='input_27[]' id='input_179_27_2' value=''   aria-required='true'   placeholder='DD' min='1' max='31' step='1'\/>\n                                        <label for='input_179_27_2' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Day<\/label>\n                                    <\/div><div class='gfield_date_month ginput_container ginput_container_date gform-grid-col' id='input_179_27_1_container'>\n                                    <input type='number' maxlength='2' name='input_27[]' id='input_179_27_1' value=''   aria-required='true'   placeholder='MM' min='1' max='12' step='1'\/>\n                                    <label for='input_179_27_1' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Month<\/label>\n                               <\/div><div class='gfield_date_year ginput_container ginput_container_date gform-grid-col' id='input_179_27_3_container'>\n                                    <input type='number' maxlength='4' name='input_27[]' id='input_179_27_3' value=''   aria-required='true'   placeholder='YYYY' min='1920' max='2027' step='1'\/>\n                                    <label for='input_179_27_3' class='gform-field-label gform-field-label--type-sub screen-reader-text'>Year<\/label>\n                               <\/div>\n                            <\/div><\/div><\/li><li id=\"field_179_15\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Guardian Details:<\/h2><\/li><li id=\"field_179_16\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_179_16'>\n                            <span id='input_179_16_3_container' class='name_first gform-grid-col' >\n                                                    <input type='text' name='input_16.3' id='input_179_16_3' value=''   aria-required='true'    \/>\n                                                    <label for='input_179_16_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                               <\/span>\n                            <span id='input_179_16_6_container' class='name_last gform-grid-col' >\n                                                    <input type='text' name='input_16.6' id='input_179_16_6' value=''   aria-required='true'    \/>\n                                                    <label for='input_179_16_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            <div class='gf_clear gf_clear_complex'><\/div>\n                        <\/div><\/li><li id=\"field_179_17\" class=\"gfield gfield--type-number gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_179_17'><span class='gform-field-label__text'>Preferred Phone Number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_17' id='input_179_17' type='number' step='any'   value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_179_18\" class=\"gfield gfield--type-number field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_179_18'><span class='gform-field-label__text'>Secondary Phone Number<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_18' id='input_179_18' type='number' step='any'   value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_179_32\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_179_32_container'>\n                                <span id='input_179_32_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_32' id='input_179_32' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_179_32' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_179_32_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input class='' type='email' name='input_32_2' id='input_179_32_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_179_32_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_179_19\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Extra Comments:<\/h2><\/li><li id=\"field_179_33\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_179_33'><span class='gform-field-label__text'>Is there anything else you would like us to know about you or your baby? (eg. Was your baby born prematurely?  Are there any special needs for you or your baby? etc.)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_179_33' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='No.' >No.<\/option><option value='Yes, we have special considerations.' >Yes, we have special considerations.<\/option><\/select><\/div><\/li><li id=\"field_179_21\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_179_21'><span class='gform-field-label__text'>Please provide details&#8230;<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_179_21' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_179_34\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_179_34'><span class='gform-field-label__text'>How did you first hear about Healthways BrainWave Babies?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_34' id='input_179_34' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Friend or Family' >Friend or Family<\/option><option value='Mothers\/Fathers\/Parents Group' >Mothers\/Fathers\/Parents Group<\/option><option value='Maternal Health Centre' >Maternal Health Centre<\/option><option value='Social Media' >Social Media<\/option><option value='Internet Search' >Internet Search<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_179_22\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_179_22'><span class='gform-field-label__text'>Please provide details&#8230;<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_179_22' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_179' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_179' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_179' id='gform_theme_179' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_179' id='gform_style_settings_179' value='{&quot;inputPrimaryColor&quot;:&quot;#204ce5&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_179' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='179' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='AUD' value='P+eto\/rAps6LerEJVP00+v3y9J\/9eRwgj3Er1iYaz3lOPus9FkGp17cwwVheuCCXVOT+RNDcbDALew84mbPmwfqZ4QDgQVCTDMaQ5EbP4xLOegE=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_179' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_179' id='gform_target_page_number_179' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_179' id='gform_source_page_number_179' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":5584,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-8792","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.healthways.com.au\/boxhill\/wp-json\/wp\/v2\/pages\/8792","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.healthways.com.au\/boxhill\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.healthways.com.au\/boxhill\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.healthways.com.au\/boxhill\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.healthways.com.au\/boxhill\/wp-json\/wp\/v2\/comments?post=8792"}],"version-history":[{"count":13,"href":"https:\/\/www.healthways.com.au\/boxhill\/wp-json\/wp\/v2\/pages\/8792\/revisions"}],"predecessor-version":[{"id":11302,"href":"https:\/\/www.healthways.com.au\/boxhill\/wp-json\/wp\/v2\/pages\/8792\/revisions\/11302"}],"up":[{"embeddable":true,"href":"https:\/\/www.healthways.com.au\/boxhill\/wp-json\/wp\/v2\/pages\/5584"}],"wp:attachment":[{"href":"https:\/\/www.healthways.com.au\/boxhill\/wp-json\/wp\/v2\/media?parent=8792"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}