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Firbank Swim School
Swim for Life
To express your interest in our
Learn to Swim
program at Firbank please complete the form below.
For competitive swimming and to learn about the
Firbank Aquastars
Swimming Club please
Click Here
"
*
" indicates required fields
Parent / Guardian 1 Contact Details
First name
*
Last name
*
Email address
*
Address Line 1
*
Address Line 2
Suburb
*
State
*
Victoria
New South Wales
South Australia
Western Australia
Queensland
Northern Territory
Tasmania
Postcode
Contact number
*
Relationship to swimmer
*
Parent / Guardian 2
Parent/Guardian 2
Check to add details for a Parent/Guardian 2, if applicable
Relationship to Parent/Guardian 1
*
husband
wife
de-facto
partner
other
First name
*
Last name
*
Address
*
Contact number
*
Relationship to swimmer
*
Swimmer Details
Swimmer First name
*
Swimmer Last name
*
Date of birth DD/MM/YYYY
*
Gender
*
Current Swimming Ability
*
Squad
Learn to Swim
Swimmer 2
Check to add details for a 2nd student, if applicable
Swimmer 2 First name
*
Swimmer 2 Last name
*
Date of birth DD/MM/YYYY
*
Gender
*
Current Swimming Ability
*
Squad
Learn to Swim
Swimmer 3
Check to add details for a 3rd student, if applicable
Swimmer 3 First name
*
Swimmer 3 Last name
*
Date of birth DD/MM/YYYY
*
Gender
*
Current Swimming Ability
*
Squad
Learn to Swim
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