Please completed ALL SECTIONS before submitting. Incomplete forms cannot be accepted.
Note: The list of clubs of which you are a member of must be completed in chronological order i.e. in order of longest CONTINUOUS membership
This section must be completed by the parent/guardian of any member under the age of 18 years. As the parent or person in the loco-parentis of the swimmer named above. I also agree to release his/her personal and other details (details available upon request)