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

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