HOLIDAY PROGRAM AND 5 DAY INTENSIVE BOOKING FORM

HOLIDAY PROGRAM AND 5 DAY INTENSIVE BOOKING FORM
Week 1: 7th January to 11th January, 2013 Week 2: 14th January to 18th January, 2013 Week 3: 21st January to 25th January, 2013
HOLIDAY PROGRAM: 8am Drop Off at NPAC - 6.00pm Pick Up from NPAC 5 DAY SWIMMING INTENSIVE HELD BETWEEN: 1pm to 3pm - Lessons 30 minutes
Child's Name:
Age: DOB:
Child's Name:
Age: DOB:
Week 1: Holiday Program M, T, W, Th, F 5 Day Intensive:
Week 2: Holiday Program M, T, W, Th, F 5 Day Intensive:
Week 3: Holiday Program M, T, W, Th, F 5 Day Intensive:
NPAC Catered: YES Self Catered: YES
Allergies: NO / YES:
Y / N Week 1: Holiday Program M, T, W, Th, F 5 Day Intensive: Y / N
N/A
Week 2: Holiday Program M, T, W, Th, F 5 Day Intensive: N/A
Y / N Week 3: Holiday Program M, T, W, Th, F 5 Day Intensive: Y / N
Swim Level: NPAC Catered: YES Self Catered: YES Swim Level:
Beginner or Allergies: NO / YES:
Beginner or
Must bring own refillable drink bottle.
Child's Name:
Age:
DOB:
Must bring own refillable drink bottle.
Child's Name:
Age:
DOB:
Week 1: Holiday Program M, T, W, Th, F 5 Day Intensive: Y / N
Week 2: Holiday Program M, T, W, Th, F 5 Day Intensive: N/A
Week 3: Holiday Program M, T, W, Th, F 5 Day Intensive: Y / N
NPAC Catered: YES Self Catered: YES Swim Level:
Allergies: NO / YES: Beginner or
Week 1: Holiday Program M, T, W, Th, F 5 Day Intensive: Y / N
Week 2: Holiday Program M, T, W, Th, F 5 Day Intensive: N/A
Week 3: Holiday Program M, T, W, Th, F 5 Day Intensive: Y / N
NPAC Catered: YES Self Catered: YES Swim Level:
Allergies: NO / YES: Beginner or
Must bring own refillable drink bottle.
Missed Days: Compensation / Refund for missed day/s is not available.
PARENT/GUARDIAN SIGNATURE:
DATE: / /
Terms and Conditions
Medical Exclusion: Children who are unwell or suffering from a contagious illness or condition should be excluded from participating in activities.
Discounts: Apply to same child attending the 5 consecutive days
I understand and accept the Terms & Conditions. I further acknowledge I have not relied upon any promise, statement or representation other than that contained in the Terms &
Conditions. I agree that the Belgravia Leisure and its servants & agents are to be free and clear of all responsibility for any loss, theft or injury whatsoever which my child may suffer
as a result of him/her participation in any activities. I have completed my childs food allergies and medical information. If my child has a food allergy I must provide my childs
snacks/lunch/drinks on each day. I understand that staff are not medically qualified to administer any medication. In addition I give permission for centre staff to seek medical
assistance at my expense should this be deemed required. I also understand that Noble Park Aquatic Centre may take photos of my children participating in activities for advertising
purposes.
PARENT/GUARDIAN NAME:
ADDRESS:
TELEPHONE:
EMAIL:
Must bring own refillable drink bottle.
PAYMENT AT TIME OF ENROLMENT REQUIRED
PROGRAM SELF CATERING: $38.00 per day $190.00 per week
PROGRAM NPAC CATERED: $48.00 Per day $240.00 per week
INTENSIVE: $54.00 per week or $50.00 for Holiday Program participants
DISCOUNT: HOLIDAY PROGRAM $200.00 catered option only if booked and
paid by 9th December, 2012