Makino Aquatic Centre

School-Age Lesson New Enrolment Form

(or click here to download a 25KB pdf version)

Parents First Name:

Parents Surname:

Childs First Name:

Childs Surname:

Childs Date of Birth:

Childs Age:

Postal Address:

Phone (Home):

Phone (Work):

Email:

Lessons for school-aged children are held after school from Monday to Thursday.

Which school term are you enrolling for?

Term One:	Term Two:	Term Three:	Term Four:

Monday:	Tuesday:	Wednesday:	Thursday:

(please tick the days you are able to attend)

Does your child have any problems that may affect them while in the water?:

Grommets:	Ear Infections:	Asthma:	ADHD:

Behavioural Problems:

Previous Bad Water Experience:

Short Sighted:

Comments:

Please answer the questions below in order to help us match your child with others of the same ability

Is your child happy to get his/her face wet?: Yes No

Will your child happily go under the water in the Learner pool by him/herself?: Yes No

Can your child lie on his/her back with ears in the water, with assistance?: Yes No

Is your child able to float on his/her tummy (eyes looking down) and back (ears in the water) without assistance?: Yes No

Is your child able to kick (without bendy knees) with a flutterboard and have his/her eyes in the water at the same time?: Yes No

Is your child able to turn his/her arms in circles while floating and kicking (no bendy knees)?: Yes No

Has your child begun to learn to breathe while swimming?: Yes No

Has your child already learned to breathe while swimming?: Yes No

Can your child swim 25 metres of the indoor pool breathing competently? i.e. with back of head on arm when breathing?: Yes No

Has your child learnt breaststroke kick?: Yes No

Does your child have the ability to swim 2+ lengths without stopping?: Yes No

Please tell us where you heard about us

Through a friend:

(friend's name)

Newspaper:

(which one)

Kindergarten:

(which one)

Play Centre:

(which one)

Plunket:

(which one)