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First Name:

Surname:

Date of Birth

Address:

Suburb:

Postcode:

Home Ph:

Mobile No:

Email Address:

Returning Student

Yes No

Preferred Time (and Level for "Learn to Swim" classes):

Learn to Swim ($55/swimmer - 8 weeks, starting Monday 13 February through to April 6 2012)

Appropriate Level

(Choose lower level if unsure)

Level 1:

Must be confident in the water and be able to put face and head in water (minimum age 6).
(20 min sessions - 1:4 coach:swimmer)

Level 2:

Can streamline with kicking 15 m on front and back. Can float front and back. Can do basic arm circles. (30 min sessions - 1:6 coach:swimmer)

Level 3:

Can do arm circles front and back and breath well on both sides (bilateral) when on front for 20 m. (30 min sessions - 1:6 coach:swimmer)

Level 4:

Can bilateral breath freestyle for 30 m (1 length of Northcote pool.) Can backstroke and has basic breaststroke arms and legs. (30 min sessions - 1:6 coach:swimmer)

Preferred Time:

Level 1
(20 min sessions)

Mon 3.30pm FULL

Wed 3.30pm FULL

Thurs 3.30pm FULL

Mon 3.50pm FULL

Wed 3.50pm FULL

Thurs 3.50pm FULL

Mon 4.10pm FULL

Wed 4.10pm FULL

Thurs 4.10pm FULL

Level 2
(30 min sessions)

Mon 3.30pm FULL

Wed 3.30pm FULL

Thurs 3.30pm FULL

Mon 4.00pm FULL

Wed 4.00pm FULL

Thurs 4.00pm FULL

Level 3
(30 min sessions)

Mon 3.30pm FULL

Wed 3.30pm FULL

Thurs 3.30pm FULL

Mon 4.00pm FULL

Wed 4.00pm FULL

Thurs 4.00pm FULL

Level 4
(30 min sessions)

Mon 3.30pm FULL

Wed 3.30pm FULL

Thurs 3.30pm FULL

Mon 4.00pm FULL

Wed 4.00pm FULL

Thurs 4.00pm FULL

Squad Swimmers ($130/swimmer - 10 weeks, starting Tuesday 31 January through to April 6 2012)

Preferred Time: (60 min sessions)

Tues 3.30pm
Tues 6.30pm FULL

Note: both squads combine for Thursday 6.30pm

Adult Swimmers

Not available until we know numbers for Squad Swimmers

Medical Conditions? Yes No

Details:

I herby give consnet for Northcote Swim Club to email me newsletters and enrolment confirmations at the above address.

Signed:

Payment Information

Please advise how you are planning to pay your tuition fees as we offer both internet banking and cheque payment,
so need to ensure we can match payments.

I am paying by:

Cheque

Internet banking


 

PLEASE NOTE: INTERNET BANKING IS OUR PREFERRED METHOD OF PAYMENT AS IT SIMPLIFIES MANAGING PAYMENTS

Bank Account No. for online payments:
ASB 12 3035 0472060 00
Particulars: Child(s) Surname
Code: Child(s) Name/Initials
Reference: Term

Term 1, 2012 Enrolment - CLOSED EXCEPT FOR SQUAD - SEE BELOW

Please complete all applicable details below to register for TERM 1, 2012. If you have any questions click here to contact the Northcote Swim Club Committee. Note: Enrolments will be cleared every 3rd day, and will not be cleared over Christmas/New Year period so confirmations may not be immediate.
For "Learn to Swim" classes, please select the Appropriate Level for your child so we can best allocate numbers.
(For Squad Swimmers, you can ignore this).

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Northcote Swimming Club Enrolment Form

The club is a non-profit organisation run by a committee of volunteers.  Our fees cover the cost of pool hire and coaches. We're always looking out for swimmers or parents keen to help out, so if this sounds like you, please contact info@northcoteswim.org.nz

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