Membership Enquiry
Swimmers Name?
*
First Name
Surname
Swimmers Date of Birth?
*
/
Day
/
Month
Year
Date
Parent/Guardian Name(if swimmer is under 18)
First Name
Surname
Email address for correspondence?
*
example@example.com
Is the Swimmer currently taking swimming lessons?
*
Yes
No
What stage/level are they currently in?
Where do they take lessons?
Can the Swimmer complete 25 metres Butterfly
*
Yes
No
Can the Swimmer tumble turn?
*
Yes
No
Can the Swimmer Dive from the side?
*
Yes
No
Does the swimmer have any disabilities including any special educational needs (SEND) that we need to be aware of
*
Yes
No
Please provide further information
*
How did you hear about club?
*
Please Select
Internet search
Social Media
Recommendation
Notice Board
Mail shot
Submit
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