Fastlane Holiday Program

Please complete the below expression of interest form if you are interesting in our Fastlane School Holiday program and are not a GELSS member or would like help from our Swim School team.

Responsible person details

First name *

Last Name *

Email *

Address *

Mobile number *

Student details

First name *

Surname *

Date of birth (dd/mm/yy) *

Medical information (if applicable)

Do you want to enrol another student? *

Yes

Membership details

Membership type *

GELSS Member

Non-Member

Cost
GELSS Members: $61.00

Non-Members: $125.00

Please confirm the dates you are interested in registering for: *

Monday 13 to Friday 17 January

Monday 20 to Friday 24 January

Level if known

GEL Staff member name (if applicable)

Terms and conditions

Subject to Glen Eira Leisure membership terms, I understand that fees paid in advance are not refundable. Refunds of fees paid will be available if the program is cancelled or medical evidence is provided showing participation in program will cause you physical harm or injury. *

I understand full payment for program must be provided within 24 hours of sign up to secure program bookings. *

I have read and I am familiar with the full Glen Eira Leisure membership terms and the Glen Eira Leisure rules. If this application is accepted, I understand that my membership with Glen Eira Leisure will be governed by those terms and rules, as amended from time to time. *

Confirm you are not a robot

Please Confirm You Are Not a Robot *

Swim Carnival Season:

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Fastlane Holiday Program

National Relay Service (NRS)