Swim-Safe | Your Learn-To-Swim School
Enrollment Application Form
Please complete all sections clearly and legibly in block letters.
1. Enrollment Type
Who are you enrolling? (Please tick one)
2. Parent / Guardian Information
First Name
Last Name
Email Address
Phone Number
ID Number
Home Address
3. Emergency Contact
Contact Name
Contact Phone
Relationship to Child
4. Learner / Child Information
Complete a block for each learner. If enrolling as an adult, complete Learner 1 with your own details. Leave unused blocks blank.
Learner / Child 1
First Name
Last Name
Date of Birth (DD/MM/YYYY)
Gender (circle one: Male / Female)
Swimming Experience (circle one: None – First time / Some experience / Can swim independently)
Preferred Level (circle one: Level 1: Starfish / Level 2: Turtle / Level 3: Fishy / Level 4: Dolphin)
Reason for Enrollment
Allergies
Medical Conditions
Current Medications
Special Requirements / Needs
Learner / Child 2
First Name
Last Name
Date of Birth (DD/MM/YYYY)
Gender (circle one: Male / Female)
Swimming Experience (circle one: None – First time / Some experience / Can swim independently)
Preferred Level (circle one: Level 1: Starfish / Level 2: Turtle / Level 3: Fishy / Level 4: Dolphin)
Reason for Enrollment
Allergies
Medical Conditions
Current Medications
Special Requirements / Needs
Learner / Child 3
First Name
Last Name
Date of Birth (DD/MM/YYYY)
Gender (circle one: Male / Female)
Swimming Experience (circle one: None – First time / Some experience / Can swim independently)
Preferred Level (circle one: Level 1: Starfish / Level 2: Turtle / Level 3: Fishy / Level 4: Dolphin)
Reason for Enrollment
Allergies
Medical Conditions
Current Medications
Special Requirements / Needs
5. Shared Medical Information
Medical Aid Provider
Medical Aid Number
Medical Aid Plan / Option
Doctor's Name
Doctor's Phone
6. Swim-Safe School Rules
These rules ensure a safe, respectful, and joyful learning environment for all our swimmers.
👨👩👧 Supervision & Access
- Children must be accompanied by a responsible adult to and from lessons
- Only authorized staff and enrolled children may enter the pool area
- Parents/guardians must remain outside the pool zone during lessons
- No child may enter the pool without a qualified instructor present
🛟 Safety First
- No running, pushing, dunking, or rough play in or around the pool
- Diving is strictly prohibited unless explicitly taught by the instructor
- Children must stay within their designated swim zones
- No child may swim alone
- Children feeling tired, dizzy, or unwell must exit the pool immediately
- All injuries or accidents must be reported to staff immediately
🧼 Hygiene & Health
- No swimming with open wounds, contagious illnesses, or recent vomiting
- Spitting, nose-blowing, or urinating in the pool is strictly prohibited
- No eating, drinking, or chewing gum in the pool area
👕 Dress Code & Equipment
- Proper swimwear is required (no underwear or street clothes)
- Swim caps are encouraged
- Floatation devices may be used only with instructor approval
- Goggles must be properly fitted
- No glass containers, sharp objects, or pets allowed near the pool
📦 Personal Belongings
- Swim-Safe is not liable for lost or stolen items
- Label all belongings clearly
🚨 Emergency Protocol
- Instructors are trained in CPR and emergency response
💬 Respect & Conduct
- Children must listen to instructors and follow directions
- Disruptive behavior may result in temporary removal from the pool
- Bullying, teasing, or exclusion is not tolerated
- Staff may not be distracted during lessons
7. Privacy & Data Protection (POPIA)
Your Privacy Matters: Swim-Safe is committed to protecting your personal information in accordance with South Africa's Protection of Personal Information Act (POPIA, Act 4 of 2013).
- We collect only information necessary for swim school operations and your child's safety
- Your data is stored securely and never shared with third parties without consent
- You have the right to access, correct, or request deletion of your information at any time
- Medical information is kept confidential and used only for safety purposes
- We implement security measures to protect against unauthorized access
- Contact us at info@swimsafe.co.za if you have any questions about your data
How We Use Your Information
- Class Management: Scheduling, attendance tracking, and communication
- Safety & Medical: Emergency contacts, medical information for learner safety
- Progress Tracking: Skill assessments and report cards
- Billing: Payment processing and invoicing
- Communication: Class updates, reminders, and important announcements
Photo & Video Policy: We may take photos/videos for progress documentation. Parents will be notified separately before any images are used for marketing purposes.
Data Retention: We retain your information for as long as you're enrolled, plus 12 months for record-keeping, unless you request earlier deletion.
8. Declaration & Consent
I confirm that I have read, understood, and agree to the following: (Please tick each)
By submitting this form, you acknowledge that Swim-Safe will process your personal information in accordance with POPIA and our Privacy Policy.
Parent / Guardian Signature
Date (DD/MM/YYYY)
Swim-Safe | Your Learn-To-Swim School • Enrollment Application Form • Please return completed form to the school office or email to info@swimsafe.co.za