9-10years Patron Shield Preparation Clinic

1
Contact Details* This field is required.Please fill out the swimmers name, parent / guardian name, contact email and number
Swimmer's Name
Parent / Guardian Name
Parent/ Guardian Email
Parent / Guardian Contact Phone Number
2
I would love to be a part of this Swimming Gold Coast Development Clinic?* This field is required.
YESNO
3
Swimmer's Date of Birth* This field is required.
Date
Day
Month
Year
4
Which club are you a member of?* This field is required.
AB Paterson SC
All Saints SC
Beaudesert SC
Belgravia Swim Team - Gold Coast
Bond SC
Emmanuel College SC
Griffith Uni SC
Gullivers Coomera SC
Helensvale SC
Jimboomba SC
Kennedy Pacific SC
Lawrence SC
Miami SC
Palm Beach Currumbin SC
Rathdowney SC
Sharks Aquatics
Somerset College SC
Southport Olympic SC
St Hilda's Aquatics
Superfish
Surfers Paradise
Trinity College SC
TSS Aquatics
Other
Swim Club
5
Coaches Name* This field is required.For notification and acknowledgement
6
Have you spoken to your coach and received their permission for attending this event? This is a prerequisite.* This field is required.
YESNO
7
Do you have any medical conditions/injuries that the coaching staff need to be aware of for this clinic?* This field is required.
YESNO
8
Please describe the medical condition / injury.
Huge
Large
Normal
Small
Ok
Ok
9
Injury / Illness Consent
I hereby give permission for my child/ward to participate in the above listed Swimming Gold Coast Regional activity. Additionally, in the event of any accident or illness I authorise GCRSA or its appointed Team Management / Coaching Staff to obtain such medical assistance my child / ward may require.
Should be Empty: