Learn to Swim Registration

Learn to Swim Registration Form

New enrolments in the 400 Gold Programme for Term 3, 2012 will close Monday 11 June, 2012.
Enrolments for the Explore and Learn Programme are now open and will close Monday 11 June, 2012. The Explore and Learn Programme will start in Term 3, 2012.
If you previously enrolled a child that was under 4.5yrs in the 400 Gold programme before the Explore and Learn programme was open for registrations, you will need to resubmit your registration and answer the questions for the Explore and Learn Programme.

Family Name

Parent's Name(s)

Address

Home Phone

Work Phone

Mobile Phone

Emergency Contact Name

Emergency Contact Number

Child's Name

Gender

Male
Female

Date of Birth (yyyy/mm/dd)

Swimming Program Details (click to enlarge)

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I feel my child would best fit the:

Has your child had any previous swimming lessons?

Yes
No

If yes, when did these lessons start?

When was the last lesson?

Does your child have any fears that may affect their swimming program?

Medical Conditions

Preferred day(s) for lessons

Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

If you have any queries regarding the swim program, you can reach us through the following details:

Jane Sullivan - Recreation Facilities Programmes Team Leader
- Phone (Direct Dial): (03) 687 7226
- Email: jane.sullivan@timdc.govt.nz
Jeremy Lane - Recreation Facilities Membership Services
- Phone (Direct Dial): (03) 687 7208
- Email: jeremy.lane@timdc.govt.nz

Note that all information collected is solely for the TDC Swimming Program, and will not be used for any other purpose.