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.

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* 1. Responsible Person Contact Information

Full Name

Address

Suburb

State

Postal Code

Email Address

Phone Number

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* 2. Participants information

Name

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* 3. Participants Date of Birth

Date

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* 4. Nature of disability or neurological difference

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* 5. Gender of participant

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* 6. Is your availability for lessons restricted to out of school hours?

Yes

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* 7. How would you define their swimming level, experience and comfort in water

Beginner

Intermediate

Advanced

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* 8. Does the participant need a hoist or ramp entry to safely enter the pool?

Yes

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* 9. Emergency Contact (other than nominated parent/guardian)

Name

Phone Number

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* 10. Emergency Contact (other than nominated parent/guardian)

Name

Phone Number

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* 11. Which class type would the participant be best suited for?

One on One Lessons

Small Group Lessons - Either Two to Three Students

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* 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.

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* 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.

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* 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.

Equal Access Program Enrolment Form

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* 1. Responsible Person Contact Information

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* 2. Participants information

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* 3. Participants Date of Birth

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* 4. Nature of disability or neurological difference

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* 5. Gender of participant

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* 6. Is your availability for lessons restricted to out of school hours?

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* 7. How would you define their swimming level, experience and comfort in water

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* 8. Does the participant need a hoist or ramp entry to safely enter the pool?

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* 9. Emergency Contact (other than nominated parent/guardian)

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* 10. Emergency Contact (other than nominated parent/guardian)

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* 11. Which class type would the participant be best suited for?

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* 12. Everyone that enters DKHAC needs to agree to the Conditions Of Entry

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* 13. Everyone that enters DKHAC needs to agree to the Conditions Of Entry

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* 14. Everyone that enters DKHAC needs to agree to the Conditions Of Entry

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* 15. Other Important comments or information: