107 Panorama Rd Rooihuiskraal Fax: 086 605 8006 083 264 6187
STUDENT INFO DATE : Date of Birth : Age : Grade : Learn to Swim : 1 2 Private Lessons : Parent and Baby : FOR OFFICE USE ONLY Adult Aqua Aerobics : 1 1 2 2 Nationality : RSA Other MEDICAL INFO Sex : Male Female Health Population Group : Cronical Illness : Home Language : Afr Eng Other Allergies : EMERGENCY CONTACT NUMBERS Father : Mother : Guardian 1 : Guardian 2 : NEXT OF KIN INFO Name & Tel : Cell : E-mail : Address : Relationship : Name & Tel : Cell : E-mail : Address : Relationship : Medication : Medical Aid Medical Aid : Private : Name of Aid : Plan : Member : Main Member : Person responsible for Account : Doctor Name & Tel : Business Address : SWIMMING HISTORY First Enrolment of Student : Was Student previously in a? Previous School : Level Completed : Anything we need to know about the Student :
INFO OF PARENT/GUARDIAN 1 INFO OF PARENT/GUARDIAN 2 Title : Initials : Title : Initials : ID Number : Home Language : Afr Eng Other Communication Preference : SMS E-mail ID Number : Home Language : Afr Eng Other Communication Preference : SMS E-mail Language Preference : Afrikaans English Language Preference : Afrikaans English Cell : Cell : Home : Home : Work : Work : Fax : Fax : E-mail Address : E-mail Address : Residential Address : Residential Address : Postal Address: Postal Address: Occupation : Occupation : Employer : Employer : Employer Physical Address : Employer Physical Address : Does Student stay with this Parent/Guardian? Does Student stay with this Parent/Guardian? Is this Parent/Guardian responsible for this account? Is this Parent/Guardian responsible for this account? PERMISSION AND INDEMNITY This agreement acknowledges parental or guardian consent for (child's name) to participate in swimming instruction at MIERSHOOP. The named student(s) health permits participation in water activities. I acknowledge that it is my responsibility to determine with student's medical doctor if medical condition contraindicates participation in the swimming programme. In consideration of permitting the above named student(s) to enroll in MIERSHOOP, I hereby voluntary release, discharge, wage and relinquish any and all actions or causes of action for personal injury, property damage as a result of engaging in said lessons. I acknowledge that I am authorized and empowered to sign this agreement, that I have fully read and understand the foregoing paragraphs and have been fully and completely advised of the potential danger incidental to engaging in swimming activities and am fully aware of the legal consequences of signing this document.. Dated at on 20 Signature of parent / guardian Witness
Enrolment TERMS & CONDITIONS 1. Contact details including name, address and telephone number will be required as part of the enrolment process. An Enrolment Form must be completed and signed. 2. Copies of the paying parent Identification document, must be attached to the enrolment form. 3. The Medical Information section needs to be completed before the Enrolment can be finalised. 4. An admin/registration payment in required with enrolment. A place cannot be confirmed unless the Enrolment Form and payment has been made. Places are allocated on a first come first served basis. 5. All parents and swimmers must agree and adhere to MIERSHOOP s Pool Rules. 6. MIERSHOOP will not be liable for the misplacement or loss of any articles belonging to the swimmer. Please make sure all items are marked clearly. Payment 7. All lessons must be paid for in full in the beginning of the month. Payment must be before the 2nd of each month. All queries regarding accounts must be made by e mail miershoopsentrum@gmail.com. 8. When paying for swimming lessons you are agreeing to the Terms and Conditions of the MIERSHOOP. 9. Payment can be made by bank bransfers or cheques. (Post dated cheques will not be accepted) 10. Lessons or Payments are non transferable. 11. Annual fee adjustments will be effective from February each year do not forget. 12. A penalty of 10% of the value of the outstanding account will be levied for outstanding accounts that exceed one months. 13. Account that is 1 months outstanding will be handed over to debt collectors. 14. All cost associated with the collection of fees from debt collector will be for your account. tice Period 15. One calendar month written or e mail notices is required to discontinue with swimming instruction. verbal or SMS cancellation will be accepted. Failing to do so will result in you being liable for that months instruction fees. 16. NO notice will be accepted in October or vember for cancellation of lessons in December. 17. NO notice will be accepted in March or April for cancellation of lessons. tice for June/July winter break must be email before 10th May. Missed Class Policy Private lessons 18. The requires notification of all absences. tification can be made in person or by sms (083 441 1625). 19. All private lesson notifications must take place early in the morning before 09h00 am. 20. n attended lessons are forfeited and are non refundable. Extreme Weather Conditions 21. The rendering of a decision regarding swimming classes under the influence of weather conditions rest with us. Any weather related notifications from the parent must be at least 2 hours in advance. Missed Class Policy Instructor 22. Should the Instructor not be able to do a lesson on that specific day, we will provide you with 2 (two) separate dates for make up lessons. If one of this dates is not suitable, this lesson will automatically be forfeit. 23. Although every effort is made to ensure a high consistency of instructors, circumstances beyond the s control sometime prevent this, eg staff illness, timetables, etc. We will make every effort to inform you of any changes. Swimming Instructor Policy 24. All swimming instructors at MIERSHOOP Aquatic Centre are LTS (Swim SA) qualified recognised as the premier teacher of swimming qualification.
FEES / FOOIE 2017 BANKING DETAILS / BANKBESONDERHEDE MIERSHOOP SWIM SCHOOL, FNB, Acc no: 623 6479 0561, Branch code: 250 655 Reference: Name & Surname or Account Number ADMIN AND REGISTRATION FEE / ADMIN EN REGISTRASIE FOOI R400 NURSERY SCHOOLS / ADMIN AND REGISTRATION FEE R300 AQUA AEROBICS / ADMIN AND REGISTRATION FEE R200 BABY & PARENT SWIM 1 x per week R400 per Month OR R 1200 per Term 2 x per week R545 per Month OR R 1635 per Term Monday & Wednesday 18:00-18:30 ONCE OFF 6 MONTHS 2 YEARS LEARN TO SWIM LESSONS / LESSE SWIMMING IN A GROUP WITH MORE THAN 2 CHILDREN 1 x per week R400 per Month (x12) OR R 1200 per Term 2 x per week R545 per Month (x12) OR R 1635 per Term 2+ YEARS LEARN TO SWIM Nursery School R50 PER MONTH EXTRA FOR TRANSPORT 1 x per week R450 per Month (x12) OR R 1350 per Term 2 x per week R595 per Month (x12) OR R 1785 per Term ADULT SWIMMING 1 x per week R440 per Month (x12) OR R 1320 per Term 2 x per week R660 per Month (x12) OR R 1980 per Term Monday & Wednesday 18:30-19:15 AQUA AEROBICS 1 x per week R240 per Month (x12) OR R 720 per Term 2 x per week R400 per Month (x12) OR R 1200 per Term Tuesday & Thursday 08:00-08:45 & 18:00-18:45 NOTICE PERIOD: ONE MONTH BEFORE THE END OF THE TERM