Date today
-
Day
-
Month
Year
Date
Department
Campaign
Location
Lead Source
Sales Stage
Admin Notes
Attention: Please check if customer has a contract in links first before contacting. Admin
SALT Location
Please Select
Aquadome
Bayfit
Belmont
Beerwah
Buderim
Camden
Coolum
Cotton Tree
Eumundi
Gatton
Hurstville
Lambton
Lane Cove
Melton
Mosman
Moss Vale
Mount Annan
Oran Park
Palmwoods
Sans Souci
Windy Hill
Your Location
*
Please Select
Aquadome
Bayfit
Belmont
Beerwah
Buderim
Camden
Coolum
Cotton Tree
Eumundi
Gatton
Hurstville
Lambton
Laidley
Lane Cove
Melton
Mosman
Moss Vale
Mount Annan
Oran Park
Palmwoods
Sans Souci
Windy Hill
Name
*
First Name
Last Name
Email
*
example@example.com.au
Mobile Number
*
Please enter a valid phone number.
Format: 0000000000.
Student Details
Student First Name
*
Gender
*
Please Select
Male
Female
Other
I prefer not to say
Student Date of Birth
-
Day
-
Month
Year
Date
What is the current / last level they were enrolled in with SwimFit?
Please Select
Tadpoles/Goldfish
Turtles
Squids
Jellyfish
Starfish
Seahorses
Jellyfish
Starfish
Seahorses
Seals
Stingrays
Mantarays
Dolphins
Is {child_name} at school?
Yes
No
Child Age
Child Age Calculation
As of next year, has {child_name} started Primary School?
*
Yes
No
Has {child_name} had any swimming lessons previously?
*
Yes
No
Has {child_name} had any swimming lessons previously?
*
Yes
No
Has {child_name} had any swimming lessons previously?
*
Yes
No
Can {child_name} swim independently - no flotation aids?
*
Yes
No
Can {child_name} swim 50m of all 4 strokes; freestyle, backstroke, breaststroke, butterfly and perform a tumble turn?
*
Yes
No
Can {child_name} swim breaststroke?
*
Yes
No
Can {child_name} swim 12m of freestyle and backstroke, perform a basic breaststroke and butterfly kick?
*
Yes
No
Can {child_name} perform a basic breaststroke kick?
*
Yes
No
Can {child_name} swim 12m freestyle with a basic breathing pattern?
*
Yes
No
Can {child_name} swim independently and are they able to perform basic freestyle?
*
Yes
No
Is {child_name} confident and able to swim independently?
*
Yes
No
Can {child_name} swim freestyle with a basic breathing pattern and backstroke?
*
Yes
No
Can {child_name} confidently swim freestyle and backstroke, basic breaststroke and butterfly kick?
*
Yes
No
Is {child_name} confident and able to swim independently?
*
Yes
No
Can {child_name} swim freestyle with a basic breathing pattern and basic backstroke?
Yes
No
Comment
AC Location
Your Level - Aquatots
Your Level - Squid
Your Level - Waterplay
Your Level - Starfish
Your Level - Clownfish
Your Level - Seahorse
Your Level - Stingray
Your Level - Angelfish
Your Level - Jellyfish
Your Level - Platypus
Your Level - Dolphin
Your Level - Squads
Your Level - Adolescent Beginner
Your Level - Adolescent Intermediate
Your Level - Adolescent Advanced
Your Level - Adult Beginner
Your Level - Adult Intermediate
iClass Locatons
Please Select
Casula
Lakelands
Mill Park
South Morang
iClass Location code
utm_source
utm_medium
utm_campaign
utm_content
utm_term
device
placement
Next Step...
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