Lane Cove Aquatic Centre

Kids Holiday Program Enrolment Form

Child 1 Name: *
Date of Birth: *
School Attending: *
Child 2 Name:
Date of Birth:
School Attending:
Address *
Suburb: *
Postcode: *
Parent/Guardian's Name: *
Work Number *
Home Number *
Mobile Number *
Email: *
Emergency information Name: *
Relationship *
Work Number *
Home Number: *
Mobile Number *
Medical Conditions: (Allergies, Asthma, epilepsy, disabilities, heart conditions etc.)
Medications:
Child can swim 25m: * Yes No