Junior SWIMMING LESSONS REGISTER YOUR INTEREST FORM

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Please provide your child’s full name

Please provide your child’s date of birth (DD-MM-YYYY)

Please select the most applicable option

Please provide a valid email address

Please provide a landline or mobile number

Please select the level of the swimmer. If you are unsure, we will assess each child during their first lesson to ensure the stage is right for them, or you can look at the expected outcomes of each Swim England Learn to Swim Pathway stage: www.swimming.org/learntoswim/asa-learn-to-swim-awards-1-7/

Does the swimmer suffer from any medical/behavioural conditions or disability?

Please include details on how any medical conditions affect the child’s swimming/behaviour and if there is any additional support required.

Please include their name and member ID

In the event of any emergency, if I cannot be reached, I hereby give my consent for my child to be transported to hospital and/or given any medical, surgical or dental treatment. In the event of an accident I hereby give my consent for a trained member of staff to administer first aid. I will advise the Swimming Teacher as soon as possible of any change in circumstances as detailed on this form.

I agree to comply with UoB Sport & Fitness’s Conditions of Use. These can be found in the footer of the UoB Sport & Fitness website.