ABN 78 315 337 803 MELBOURNE AQUATIC HOLIDAY CAMP ENROLMENT FORM January 2015 Holiday Program A full day program with activities including; two swimming sessions, team games, crafts, videos & cooking Venue: Days: Session Time: Swimmer Level: Age: Cost: Korowa Anglican Girls’ School Tuesday 20 January and/or Thursday 22 January 8:30am to 3:30pm Suitable for swimmers from Red to Development Squad 5years and over $65.00 per day Contact Details Parent/ Guardian Name: Address: Phone No: Mobile: Email: Swimmer Details Name Date of Birth Current Level Day(s) Attending Medical Conditions ___/___/___ ___/___/___ ___/___/___ Payment Details Credit Card (please circle) VISA MasterCard Card Holder’s Name Card Number __ __ __ __ / __ __ __ __ / __ __ __ __ / __ __ __ __ Expiry Date __ __ / __ __ Total Amount $ Card Holder’s Signature Terms and Conditions    In the event of illness or accident and if I am unable to be contacted, I authorise Melbourne Aquatic to obtain, on my behalf, such medical treatment as my child may require. If my child is unable to attend lessons due to illness or injury, the Melbourne Aquatic office must be notified prior to the lesson commencing on 9885 9896. A credit note may be issued under these circumstances upon medical certificate. All programs are subject to cancellation should there be insufficient numbers. I have read, understand and agree to the Terms and Conditions as set out above. Signature of Parent/Guardian: ____________________________________Date:____/_____/_____ Please complete and return enrolment form with full payment by Friday 19 December to secure your booking. Melbourne Aquatic Learn to Swim Korowa Anglican Girls’ School Ranfurlie Crescent, Glen Iris VIC 3146 T: (03) 9885 9896 l E: [email protected] Managed by Melbourne Vicentre Swimming Club Box 8 Melbourne Sports & Aquatic Centre Aughtie Drive, Albert Park VIC 3206 T: (03) 9926 1518 E: [email protected] | www.vicentre.org.au