Clone of Intention to Swim or Withdraw - 2025 NSW LC Preparation Meet

1
Swimmer Name* This field is required.
First Name
Last Name
2
Date of Birth* This field is required.
Date of Birth
Day
Month
Year
3
Contact Email - for confirmation* This field is required.
example@example.com
Email Verified
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Please check your mailbox and paste the code below to complete verification
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4
Club* This field is required.
Please enter your club
5
Female / Male* This field is required.
Female
Male
6
Which Male event are you registering your intention for?* This field is required.
Please Select
Please Select
Event 5 - 11 years & over Boys 800m Freestyle
Event 13 - 12 years & over Boys 400m IM
Event 17 - Boys 400m Freestyle
Event 33 - 12yrs & over Boys 1500m Freestyle
7
Which Female event are you registering your intention for?* This field is required.
Please Select
Please Select
Event 6 - 11 years & over Girls 800m Freestyle
Event 14 - 12 years & over Girls 400m IM
Event 18 - Girls 400m Freestyle
Event 34 - 12yrs & over Girls 1500m Freestyle
8
Are you intending to swim this event?* This field is required.
YESNO
9
Please confirm in writing that you are intending to withdraw.* This field is required.
10
Name of person completing the form.* This field is required.
11
Relationship of person completing the form to the named swimmer.* This field is required.ie, Swimmer, Coach, Parent
12
Contact number of person completing this form.* This field is required.
Please enter a valid mobile phone number.
13
Signature of person completing the form* This field is required.
Should be Empty: