Summit Swim and Aquatic
791 Ballina Road, Goonellabah, NSW 2480
02 66252025
ENQUIRY FORM
Family Details
Full Name (Parent / Carer)
Contact Details
Email (required)
Mobile (required)
Home Telephone
Student Details
Student 1
Student Name (required)
Date of Birth / Gender
Please select...
Male
Female
Intersex / Indetermined
Availability
Swimming Ability (if applicable)
Infant / toddler
Beginner / non-swimmer (3yrs+)
Water-safe / dog-paddle and breath
Starting big arms / push and glide
Strong kick and good big arms
Breathing to side with freestyle
Freestyle 25m and intro backstroke and breastroke
Freestyle 50m and backstroke and breaststroke 25m
Freestyle 100m + / Squad swimmer
Adult swimmer
Not applicable - Adult interested in AQUA
Additional Information
Additional Information / Special Requests
