Liquid Therapy Membership Registration Form

BOOKINGS CLOSED DUE TO FULL CAPACITY (waiting list only)
Welcome to Liquid Therapy's 2022 season - (complete for waiting list)
Please give us as much information as possible as this will help us to best process your application. Please consider:
- Have you chosen the most suitable program from our website?
- Is the participant between the ages of 6 and 16?
- Please only sign up one participant per form.
If the answer to all of the above is yes then please fill in the Expression of Interest and you will recieve a call from a member of the team!

ABOUT YOU

Please note all information given will be treated with the utmost confidentiality and will be stored in line with Ireland's National GDPR guidelines.
Are you applying on behalf of a community group or individual? *

Group Individual
Has the PARTICIPANT(s) been to any Liquid Therapy programs before? *
If this is your first Liquid Therapy experience please go straight to ABOUT YOU
What county are you travelling from? *
Name of Group *
Name of GUARDIAN or Contact *

First Name Last Name
What is your relationship to the PARTICIPANT(s)? *
Contact Number of Guardian or Group *
Email *
example@example.com
Please give us more information about your group and why you would like to participate in Liquid Therapy's programmes. This will help us to best assess the needs of your group and give you the best possible Ocean experience. Please include, things like any additional needs of the group, mobility, previous water experience, numbers, preferred timeframe, etc. *
The following programs are available. Please select the 2022 program or programs you are interested in: *

WAITING LISTS ONLY

Would you like to be added to our e-mailing list in order to receive updates about programmes and other news? *

Yes No
Should be Empty:

BOOKINGS CLOSED DUE TO FULL CAPACITY (waiting list only)