Limavady Amateur Swimming Club
Expression of Interest
Swimmer Name
*
First Name
Last Name
Swim Ireland Gender Identification
*
Male/Open
Female
Swimmer Date of Birth
*
-
Day
-
Month
Year
Age
-
Day
-
Month
Year
Date
Swimmer is capable of completing the following without assistance or stopping. (Please Note: only the first 2 options are essential at trial)
25m Front Crawl (1 length)
25m Back Crawl (1 length)
Breaststroke (5-10m, basic stroke mechanics)
Butterfly (5-10m, basic stroke mechanics)
Jumping into deep end, vertically from pool side
Swimmer is capable of completing the following without assistance or stopping.
50m Front Crawl without stopping (2 lengths)
50m Back Crawl without stopping (2 lengths)
50m Breaststroke without stopping (2 lengths)
Attempt 25m Butterfly
Able to dive off blocks or pool side
Scull 25m head or feet first
Tread water and somersault in water
Swimmer is capable of completing the following without assistance or stopping.
100m Front Crawl without stopping (4 lengths)
100m Back Crawl without stopping (4 lengths)
100m Breaststroke without stopping (4 lengths)
Able to dive off blocks
Swimming Lessons Level achieved
Level 6 (minimum reqd.)
Level 7
Level 8
Level 9
Level 10+
Parent/Guardian Name
*
First Name
Last Name
Contact Mobile Number
*
Please enter a valid phone number.
Format: 00000-000000.
Contact Email Address
*
example@example.com
Additional Info: (e.g. Disability, special medical requirements, ..)
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