Waiting List Form

Member Details

First Name

Known As

Last Name

Date of Birth

Gender

Sex at Birth

Competition Gender

Home Phone

Mobile Phone

Address Line 1

Address Line 2

Address Line 3

Town

County

Postcode

Primary Contact Name

Relationship To Member

Medical Details

Please enter "None" for no medical issues.

Swims For Another Club

Please enter the name of the club or the word "No".

Previous Experience

Please enter any previous experience or the word "None".

Please Select The Disciplines You Are Interested In

Masters Swimming Learn to Swim

Consents

I Consent You Can Store My Information

Please confirm that the club may store your information.

To effectively run our club we will need to contact you. In entering your details here, you are automatically acknowledging this.

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