Swimming Academy Registration Form

Name of Parent/Guardian*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityCounty

Postal / Zip Code
Phone Number (Home)
Please enter a valid phone number.Format: (00000) 000000.
Phone Number (Mobile)
Please enter a valid phone number.Format: (00000) 000000.
Email*
example@example.com
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.Format: (00000) 000000.
- Name*
  
  First NameLast Name
- Date of Birth*
  
  DayMonthYear
  Date
- Gender*
  
  MaleFemale
- Current School
- Swimming Certificates received or ability*
- Name
  
  First NameLast Name
- Date of Birth
  
  DayMonthYear
  Date
- Gender
  
  MaleFemale
- Current School
- Swimming Certificates received or ability
- Name
  
  First NameLast Name
- Date of Birth
  
  DayMonthYear
  Date
- Gender
  
  MaleFemale
- Current School
- Swimming Certificates received or ability
- Medical conditions, including medication taken (If not applicable, please enter N/A)*
- 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*
  
  I can confirm
- Shrewsbury School Trading Company Safeguarding and Child Protection Policy
- We use email communication to update members on our offering and market other activities on the school site that may be of interest.
  
  If you do not wish to receive email communication please click this box.
- Should be Empty: