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.