Bright Waves - Werribee Online Registration

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Welcome to Bright Waves Swim School. Please take your time to complete all of the information that will help us with your registration. If you would prefer to call and have us book you in please call on 9749 7038 and we will be happy to help. We look forward to having you join the Bright Waves Community.

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Referral Information

How did you hear about us?*

Referral Name

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Postcode*

Contact #1

Contact #1 First Name*

Last Name *

How Can We Contact You?

Cell # *

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Portal Access (your email is your login)

Email* (Emails are kept confidential)

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Portal Account Password

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Contact #2

Contact #2 First Name

Last Name

How can we contact you?

Cell # Receive Text Message Notifications. By opting in, you agree to receive SMS messages from Bright Waves - Werribee. Standard message and data rates apply. Reply STOP to opt out

Email (Emails are kept confidential)

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Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

ENROLLING TIPS: STEP 1 - Choose relevant Program - BEGINNER WITH A CARER (4month - 4years, simply book into the relevant age bracket) - PRE SCHOOL LEARNER (Weekday mornings 3yrs - 5yrs) - LEARNER (Weeknights and Weekends 3yrs - 16yrs) - ADULT (Weeknights 16+) STEP 2. Visit www.brightwaves.com.au go to Our Programs/Certificate Levels, under this Program select a certificate level STEP 3. Select Class below

Enroll in Classes

Select Class

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date*

Additional Info

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

Enroll in Classes

Select Class

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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

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Registration

Referral Information

Family Information

Where do you live?

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

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Student #3 (Show-Hide Details)

Additional Info

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Student #4 (Show-Hide Details)

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Student #5 (Show-Hide Details)

Additional Info

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Questions or Concerns

Payment Information

Credit Card

eCheck/Bank Draft

Required Policies

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