Name (required)
Address
Telephone no.
Email (required)
If attending swimming lessons what level are you currently on?
Where do you have your swimming lessons?
Have you achieved any distance swimming badges please give details
What are your swimming goals please circle one fitness/competition/physio/other - If other please give details
Do you have any medical issues that may affect your swimming i.E asthma, eczema, allergies etc y/n - if yes please provide details
Do you have any physical or learning difficulties y/n if yes please provide details
Parent's Name
Date
By ticking this box you are agreeing to your personal data being submitted and held by Nantwich Seals Swimming club. This data will never be shared with any other third party and will be treated with the utmost care. For more information on our privacy policy please contact us through the website: I agree