Name of Parent/Guardian
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Last Name
Address
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Street Address
Street Address Line 2
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Postal / Zip Code
Phone Number (Home)
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Phone Number (Mobile)
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Email
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Emergency Contact Name
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First Name
Last Name
Emergency Contact Phone Number
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Child 1
Name
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First Name
Last Name
Date of Birth
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Day
-
Month
Year
Date
Gender
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Current School
Swimming Certificates received or ability
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Child 2
Name
First Name
Last Name
Date of Birth
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Day
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Month
Year
Date
Gender
Male
Female
Current School
Swimming Certificates received or ability
Child 3
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Last Name
Date of Birth
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Day
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Month
Year
Date
Gender
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Female
Current School
Swimming Certificates received or ability
Medical conditions, including medication taken (If not applicable, please enter N/A)
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Any other information that would be useful for instructors
I have read and understood the Shrewsbury School Trading Company Safeguarding and Child Protection Policy and will access the school site in accordance with its terms
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I can confirm
Shrewsbury School Trading Company Safeguarding and Child Protection Policy
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