The Swim Factory - Cranbourne West Online Registration

Registration

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Welcome to The Swim Factory online registration. Please enter all information requested on this form to register. You must supply credit card or bank account details for your registration to be submitted. A Direct Debit form will be emailed to you once we have processed your registration. Your enrolment fee and two week deposit payment will be processed within the next 24 hours

* denotes required fields

Referral Information

How did you hear about us?*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Postcode*

Primary Phone*

Additional Info

Emergency Contact Info not Contact #1 or #2)*

Contact #1

Contact #1 First Name*

Last Name *

Type*

How Can We Contact You?

Cell # * Receive Text Message Notifications

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Contact #2

Contact #2 First Name*

Last Name*

Type*

How can we contact you?

Cell # * Receive Text Message Notifications

Email* (Emails are kept confidential)

Confirm Email*

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level

Does your child have a diagnosed disability?*

Does your child have any learning issues?*

Allergies*

Medications*

My child has been immunised*

The class you have selected is on this form so you do not need to search. If you are not sure of the appropriate class for your child, submit the form with no class selected and we will contact you. No fees will be charged until a booking is confirmed.

Enroll in Classes

Select Another Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level

Does your child have a diagnosed disability?*

Does your child have any learning issues?*

Allergies*

Medications*

My child has been immunised*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level

Does your child have a diagnosed disability?*

Does your child have any learning issues?*

Allergies*

Medications*

My child has been immunised*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level

Does your child have a diagnosed disability?*

Does your child have any learning issues?*

Allergies*

Medications*

My child has been immunised*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

School*

Grade Level

Does your child have a diagnosed disability?*

Does your child have any learning issues?*

Allergies*

Medications*

My child has been immunised*

Enroll in Classes

Select Class

Add Another Student

Required Policies

(Show-Hide Details)

Questions or Concerns

Comments

Payment Information

Please fill out ONE of the following Payment Methods

Credit Card

Card Number

Exp Month

Exp Year

Card Nickname

Name as it appears on card

Address Line 1

Address Line 2

City

State

Postcode

eCheck/Bank Draft

Bank Name

Account Type

Your Account Name (Your name on your bank statement)

Bank State Branch (BSB) Number (6-digit number)

Account Number

Registration

Referral Information

Family Information

Where do you live?

Additional Info

Contact #1

How Can We Contact You?

Portal Access (your email is your login)

Contact #2

How can we contact you?

Student #1

Additional Info

Enroll in Classes

Student #2 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #3 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #4 (Show-Hide Details)

Additional Info

Enroll in Classes

Student #5 (Show-Hide Details)

Additional Info

Enroll in Classes

Required Policies (Show-Hide Details)

I Agree to All of the Above

Questions or Concerns

Payment Information

Credit Card

eCheck/Bank Draft

Required Policies

(Show-Hide Details)