DATES: Week 1, (4 day) Monday 21 December 2009 - Thursday 24 December 2009 Week 2, (4 day) Monday 28 December 2009 - Thursday 31 December 2009 Week 3, (5 day) Monday 04 January 2010 - Friday 08 January 2010 Week 4, (5 day) Monday 11 January 2010 - Friday 16 January 2010 Week 5, (5 day) Monday 18 January 2010 - Friday 22 January 2010 Parent Name 1: Parent Name 2: Contact Phone Number 1: Street Address: Suburb: Postal Code: Home Phone: Mobile Phone: Email: Is this a shared lesson? YES: NO: Pool Owners Name: Pool Owners Address: Preferred Day: Preferred Time: Child One: Childs Name: Date of Birth: Child Two: Childs Name: Date of Birth: Child Three: Childs Name: Date of Birth: Child Four: Childs Name: Date of Birth: Tell us about yourself! (Including any medical conditions we should be aware of): Referred By: Please Click HERE to read and agree to the Terms & Conditions Please state whether you agree to the Terms & Conditions: Do you agree to the Terms & Conditions? YES: NO:
