Online Waiting List Application Form
Date of Application
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Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of child
First Name
Last Name
Parent / Guardian's Name
Address
Town
Post Code
Email Address
Date of birth of child
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Telephone Number
Mobile Number
Swim Ability
Please Select
Beginner Swimmer (Duckling, Stage 1 or 2)
Lower Improver (Stage 3, Stage 4, STA Goldfish Series)
Higher Improver (Stage 5 & 6, STA Angelfish & Shark Series)
Advanced Swimmer Stage 7+, STA Water Safety Skills)
Any Badges previously achieved
Additional Swim Ability Notes
Youth Organisation ?
*
(IE: 7th Farnborough Scouts, 1st Farnborough Brownies)
Scout / Guide Leader
*
Please let us know your childs youth organisation leader
Signature
Please verify that you are human
*
Submit
Should be Empty: