Welcome to our Online Payment Area
Welcome to our Online Payment Area
Welcome to our Online Payment Area
Account Registration Form
This form is used to create accounts for adult and student participants.

Information
Please note that an account is required for each adult or child who will be participating in an activity.

This will be your username and will be required when you log in to Wisepay.
Please confirm your email address to ensure it has been entered correctly.
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WisePay will automatically generate a strong password when this form is submitted. You will be sent an email to the email address entered above containing your log in credentials.

Password
WisePay will automatically generate a password when this form is submitted. You will be sent an email to the email address entered above containing your log in credentials.

Participant Details
Please enter the name of the Adult / Child that will be attending the courses purchased.
Please enter the First Name of the participant in the box above
Please enter the Last Name of the participant in the box above
Please enter the date of birth of the participant
Please enter a daytime telephone number that we can use should we need to make contact with this participant
Please enter a mobile phone number that we can use should we need to make contact with this participant
Please enter an evening telephone number that we can use should we need to make contact with this participant

Participant Medical Details / Consent
Please complete the sections below. Please note that this information will be stored on WisePay against your account details.
 The participant does NOT suffer from Diabetes
 The Participant DOES suffer from Diabetes
 The participant does NOT suffer from Asthma
 The participant DOES suffer from Asthma
 The participant does NOT suffer from Epilepsy
 The participant DOES suffer from Epilepsy

 There are NO other medical conditions
 YES there are other medical conditions
Are there any other medical conditions of which the centre should be aware ?
If you selected Yes to the question above, please provide details.

 There have been NO recent ilnesses
 YES there has been a recent illness
Are there any recent illnesses of which the centre should be aware ?
If you selected Yes to the question above, please provide details.

 YES the participant can swim 50 metres
 NO the participant cannot swim 50 metres
Is the participant able to swim 50 metres ?
 YES the participant is water confident
 NO the participant is not water confident
Is the participant water confident with regard to the proposed activity ?
Please provide the approximate date of your last Tetanus Injection
 YES I do consent for you to use my photograph
 NO I do not consent for you to use my photograph
 Not Applicable
 YES I do provide authority for parental consent
 NO I do not provide authority for parental consent
If you are registering for a child do you provide authority to give parental consent ?

Guardian / Next of Kin
Please provide Guardian details if you are registering a child, or next of kin details if you are registering an adult.
Please enter a daytime telephone number that we can use should we need to make contact with the guardian / next of kin.
Please enter a mobile phone number that we can use should we need to make contact with the guardian / next of kin.
Please enter an evening telephone number that we can use should we need to make contact with the guardian / next of kin.

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Creating Multiple Accounts (For example, family members)
If you wish to create another account, perhaps for a second or third child, then please press the "Save and Create Another Account" button below.