Equal Access Program Enrolment Form The Equal-Access program is open to all children and teenagers with any form of disability or neurological difference between the ages of 5-16. Pricing for the Equal Access Program is now the exact same as the Learn to Swim program, with concession rates available. More information can be found at: www.hobartaquaticcentre.com.au/About-us/Fees-and-Charges#section-4 It is important to understand that this process is not a confirmation of you having a position in the program, it is the starting point. Question Title * 1. Responsible Person Contact Information Full Name Address Suburb State Postal Code Email Address Phone Number Question Title * 2. Participants information Name Question Title * 3. Participants Date of Birth Date Date Question Title * 4. Nature of disability or neurological difference Question Title * 5. Gender of participant Question Title * 6. Is your availability for lessons restricted to out of school hours? Yes No Question Title * 7. How would you define their swimming level, experience and comfort in water Beginner Intermediate Advanced Question Title * 8. Does the participant need a hoist or ramp entry to safely enter the pool? Yes No Question Title * 9. Emergency Contact (other than nominated parent/guardian) Name Phone Number Question Title * 10. Emergency Contact (other than nominated parent/guardian) Name Phone Number Question Title * 11. Which class type would the participant be best suited for? One on One Lessons Small Group Lessons - Either Two to Three Students Question Title * 12. Everyone that enters DKHAC needs to agree to the Conditions Of Entry I AGREE to abide by these rules and conditions. I DO NOT AGREE to abide by these rules and conditions / want to end the process. Question Title * 13. Everyone that enters DKHAC needs to agree to the Conditions Of Entry I AGREE to abide by these rules and conditions. I DO NOT AGREE to abide by these rules and conditions / want to end the process. Question Title * 14. Everyone that enters DKHAC needs to agree to the Conditions Of Entry I AGREE to abide by these rules and conditions. I DO NOT AGREE to abide by these rules and conditions / want to end the process. Question Title * 15. Other Important comments or information: Done