DLSA Enrolment Form

Save time on the day and complete your DLSA Enrolment form online! Please make sure you read and accept all relevant DLSA booking terms and conditions.

Responsible Person - Surname*

Responsible Person - First Name*

Enrolling in DLSA*

Address*

Toowoomba Suburb/other*

Phone*

Email*

Please use the same email address you used when you made your initial enquiry

Partner/Spouse Name*

If different from Emergency Contact

Emergency Contact Name (for you)*

Emergency Contact Relationship (to you)*

Emergency Contact Phone*

Child 1 Surname

Leave blank if same as your surname

Child 1 Name*

Child 1 DOB*

Child 1 Health

Enrol a 2nd Child?

Child 2 Surname

Form.label('enrol-a-2nd-child') == 'Yes'

Child 2 Name

Form.label('enrol-a-2nd-child') == 'Yes'

Child 2 DOB

Form.label('enrol-a-2nd-child') == 'Yes'

Child 2 Health

Form.label('enrol-a-2nd-child') == 'Yes'

Enrol a 3rd or more child/ren

Details of Child/ren 3 or more

Please provide all name and relevant health information

You are aware that I need to read/submit the DLSA COVIDSafe Terms and Conditions before we commence lesson.*

CovidSafe Terms and Conditions are located here - https://qrgo.page.link/y79cp

You have read & accept the DLSA Payment & Make Up Policies*

View all DLSA Policies here - https://bit.ly/2VJPWlz

You have read & accept the DLSA Perpetual Program Policy*

View all DLSA Policies here - https://bit.ly/2VJPWlz

Are you aware that as part of the Perpetual Program system, all bookings are automatically rolled over to the next program, UNLESS you submit a Deferral Form?

View all DLSA Policies here - https://bit.ly/2VJPWlz

You have read and accept the COVIDSafe Terms and Conditions*

View all DLSA Policies here - https://bit.ly/2VJPWlz

You have read and accept the CV19 Lockdown Policy*

View all DLSA Policies here - https://bit.ly/2VJPWlz

You have read and accept the Cancellation and Refund Policy*

View all DLSA Policies here - https://bit.ly/2VJPWlz

You have read and accept the Photography and Video Polity*

View all DLSA Policies here - https://bit.ly/2VJPWlz

You have read and accept the General Rules and Conditions*

View all DLSA Policies here - https://bit.ly/2VJPWlz

Are you considering paying via Direct Debt?

View all DLSA Policies here - https://bit.ly/2VJPWlz

You have read the DLSA Direct Debit Fact Sheet*

Form.label('are-you-considering-paying-via-direct-debt') == ‘Yes’

As a parent/Guardian of the above child/ren, you give my consent for him/her to participate in Learn to Swim and/or Squad Coaching programs. *

If NO, please contact our Admin Team to complete a manual hardcopy enrolment form

You give authority to the Staff and Instructors of the Darren Lange Swimming Academy to take whatever action they deem necessary to ensure the safety and well-being of the students whilst in the centre.*

If NO, please contact our Admin Team to complete a manual hardcopy enrolment form

You understand that if your child/children are under age the age of 12 and are not accompanied and or supervised by a parent/guardian, that DLSA is not liable for the safety of your child/children.*

If NO, please contact our Admin Team to complete a manual hardcopy enrolment form

You authorise Darren Lange Swimming Academy staff and Instructors to obtain medical assistance, which they deem necessary should an accident occur.*

If NO, please contact our Admin Team to complete a manual hardcopy enrolment form

You have completed the medical information regarding the above student/s and include details of limitations which he/ she may have for the activity concerned.*

If NO, please contact our Admin Team to complete a manual hardcopy enrolment form

You approve Darren Lange Swimming Academy taking photos and using images for marketing purposes.

If NO, please contact our Admin Team to complete a manual hardcopy enrolment form

If you have already submitted the form you may have received a code or a URL-link that provides you with the possibility to edit or add more information.

In some cases the web form is partly pre-filled with specific information to facilitate for you. In those cases you should also have been sent a URL-link to fill out the remaining parts.

Paste that code or the full edit-link (URL) here to open that specific webform.