Jingle Jangle Swimming Gala
Sunday 6th December at Exmouth Leisure Centre
Swimmer's Name
*
First Name
Last Name
Swimmer’s Current Swimming Stage
*
Please Select
Stage 4
Stage 5
Stage 6/7
Stage 8/9/10/Swimstars
Stage 4
*
Stage 5
*
Stage 6/7
*
Stage 8/9/10
*
Calculation
Events to Enter (Please Tick)
*
25m Butterfly
25m Backstroke
25m Breaststroke
25m Frontcrawl
100m I.M. (recommended for Stage 6+ only)
Total Number of Events
Total Cost (£3.50 per event)
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Contact Number
*
I am happy to volunteer
*
Yes
No
I consent for photos to be taken of my child
*
Yes
No
Payment Amount
*
prev
next
( X )
GBP
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
Should be Empty: