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Kelly Kuruc trading as

Little Caterpillars PTY LTD

Swimming

Their Future, Our Passion

Little Caterpillars Pty Ltd Reg #: 2017 / 150140 / 07

www.littlecaterpillars.co.za [email protected]

084 806 7652 facebook.com/littlecaterpillarsschool

Swimming Student Enrolment Form

Welcome to Little Caterpillars!

First Parent Information (Responsible for account)

Title: Cell Number:

First Name: Home Number:

Surname: Work Number:

ID/Passport No: Work/Home Number:

Date of Birth: Relation to Learner:

Email Address:

Residential Address

Street # Street Name Suburb Area Code City

Second Parent Information

Title: Cell Number:





Email Address:

Residential Address

Street # Street Name Suburb Area Code City

https://www.facebook.com/littlecaterpillarsschool/

mailto:[email protected]



Swimming





Swimming Student Information:

Gender: ID/Passport No:

First Names: Date of Birth:

Surname: Country of Birth:

Medical – Does your child suffer from any of the following?

Chest Conditions:

Ear Conditions:

Physical Injuries:

Physical Disability:

Allergies (Particularly Bee Stings)?

Doctor Details:

Doctor’s Name:

Doctor’s Number:

Emergency Contact Person (In case neither parent is reachable)

Title: Cell Number:





Email Address:

Does this individual have permission to collect your child(ren)?

Any other information the swimming instructor should know?

______________________________________________________________________________________________

______________________________________________________________________________________________

______________________________________________________________________________________________





Swimming





TERMS AND CONDITIONS (please initial all boxes and sign the final page)

I have read and understand the rules of the Little Caterpillars and agree to abide by them. I agree to pay fees owed

to the school by the 3rd of each month and to give one calendar months’ written notice to terminate the contract. I

further agree to the condition that, while every precaution will be taken for the safety and welfare of me/my

child(ren) and for the care of my/ his/her possessions, during extra-mural or private lessons I will hold blameless

and indemnify all persons, Little Caterpillars and all other organizations associated with the activity, should any

prejudice, loss, damage, illness or injury occur to me/my child(ren) during the swimming activity. This includes an

indemnity against recovery of costs resulting from damage, loss and/or medical conditions or hospitalization, unless

such loss is caused by the negligence, wilfulness or deliberate act of Little Caterpillars or one or more of its

employee’s. I understand that I am responsible for the minor outside of their lesson time. This waiver is

unconditional and is given in both my personal capacity and as a father/mother/natural/legal guardian of any minor

concerned.

Once a single lesson has been attended, it is accepted that the swimmer and his/her parent/guardian automatically accept the Terms and Conditions of Little Caterpillars as set out in this document.

FEES & OPERATING CONDITIONS

• Swimming lessons are offered exclusively to Little Caterpillars Learners and are included in their monthly school

fees. If your child(ren)’s school fees are not paid by the 3rd of the month they will not be permitted to swim until

the fees have been paid.

• There will be no discount on school fees should you wish your child(ren) be excluded from swimming lessons for

any reason whatsoever.

• Little Caterpillars swimming classes will be operate under the same hours as the nursery school and as such will

be closed for 2-3 weeks over the Christmas/New Year period.

• Swimming lessons are provided from September through to April only.

• The swimmer (participant), their parent / guardian agrees to pay all charges including legal fees which may arise

in the event that legal action and/or other action is taken by Little Caterpillars to recover any fees or amounts due,

including but not restricted to, collection commission, whether action is commenced or not.

• If for any reason you would NOT like your child to continue their swimming lessons with Little Caterpillars please

send an email to [email protected] so we can arrange other activities for them while their class is

swimming.






Swimming





POOL ETIQUETTE

• Pupils with long hair or hair treated with oils are requested to wear caps.

• No parents or other persons are allowed in the pool area during lessons. Under special circumstances, Parents

may be permitted to watch the lesson from underneath the Lapa but only when invited to do so. Please do not

disrupt the lesson or interrupt the instructor and/or students during the lessons.

• Students will NOT be permitted to enter the swimming pool at any time unless the instructor is present and grants

permission.

• There is to be NO running around, or unassisted diving or jumping into the pool.

• Please bring your own swimming caps and swimming towels and ensure that these are all clearly marked.

• Children using the pool who are not potty trained are to wear aqua nappies (the parent/guardian is required to

provide these). If your child has an ‘accident’ in the pool their parent/guardian will be responsible for the cleaning

and costs associated therewith.

I, the undersigned, hereby acknowledge that I have read, understand and agree to all terms and conditions

presented in this document. I, the undersigned, declare that all information provided by myself in the document

above is accurate and true.

Signed at ____________________ on this _____ day of _____________20____.

Mother: _______________________ Father: _______________________

Guardian: __________________



kelly kuruc trading as little caterpillars swimming...kelly kuruc trading as little caterpillars pty...

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