Swimmer Registration Form - Swimming with Natalie

All swimmers must complete a registration form.

Swimmer's Full Name*

Swimmer/Parent/Caregiver E-mail*

Swimmer/Parent/Caregiver Phone Number*

Address*

Swimmer's Date of Birth*

Swimmer's Date of Birth

Emergency Contact Details - Name, Tel no. & relationship*

Any Additional or educational needs - anything that may impact needs in the water or ability to swim*

Medical conditions, allergies, medicines (Please ensure you include all relevant medical information)*

Any additional information that will benefit you or your child’s swimming lessons (e.g preferred name, likes/dislikes in the water):

DISCLAIMER: I agree that I/my child swims at my/their own risk whilst under the instruction of Natalie Perrett and associated Instructors. It is my responsibility to seek medical advice to ensure it is safe for me/my child to join swimming lessons. I am also aware that, while every care is taken to minimise the risk of injury or accidents, I accept responsibility for my own safety or that of my child's. I accept that I will not hold Natalie Perrett or associated Instructors responsible for any injury, loss or damage at any time to myself/my child. By signing this form, I have read, understood and accept the pool rules, code of conduct and usage disclaimer. I have shared the rules and code of conduct with my child and they understand and accept these rules.

Name*

Signature (Typed is acceptable)*

Date*

Date

If signing on behalf of persons under the age of 18, please state your name and relationship to that person