Child/ Adult Registration Form

Parent/Guardian/Swimmer MUST complete Registration forms BEFORE child/adult participates in any of the SwimWell Classes.

 

Child/ Adult Registration Form

Your Address



Your Child's Date of Birth

Venues



Health Club membership number (if applicable)

Confidential Medical Section:

Does your child suffer from any medical condition or difficulties that you think we should be aware of, e.g. asthma, hearing problems, learning difficulties etc?

YesNo

If YES, please specify and list.

A parent/guardian must be available to administer any medication required during class, as this cannot be the responsibility of the instructors.


Emergency Contacts

Emergency Contact Person when at swimming, e.g. Parent, Aunt, Neighbour, Grandparent etc.



Terms & Conditions

Please see here: Terms & Conditions.

Acknowledge your acceptance of these Terms and Conditions by ticking the box below.

Yes

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.