Enrolment

Name of Parent*
First Name Last Name
Mobile Number*
Email Address*
Home Address*
Suburb*
Postcode*
Name of Swimmer*
First Name Last Name
Date of Birth*
Please enter a number from 1 to 31.
Month*
Year*
Location*
- Geelong - Highton
- Northern Suburbs - Corio
Medical Conditions
Other Comments

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