Active in the Water program
Inclusive Swim is pleased to be offering Active in the Water, a 10-week aquatic wellbeing program for adults living with chronic pain in Mount Gambier and surrounding areas. This form is to show your interest in joining the program. We are aiming for a late October/early November start date. This will be a 10 week program
Name of participant
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 0000000000.
Date of birth of participant
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Any other information you feel would be useful to share with us.
Submit
Should be Empty: