Contact Us
Your Name
*
First Name
Last Name
E-mail
*
Phone Number
*
Which Pool?
*
Ploughcroft
Rastrick
Are you ready to start now?
*
Yes
No
Do you want to be added to a waiting list to start at later date?:
*
Yes
No
If so, when would you like to start?:
The following is optional information:
Postcode:
Child Name:
Date of Birth:
Child Name:
Date of Birth:
Child Name:
Date of Birth:
Any illnesses or disabilities (deafness etc):
Please Select
Yes
No
Days & times you are available to swim:
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