Trial Request

Please complete the details below so that we can progress your trial request.

Swimmer Details

First Name

Known As

Last Name

Date of Birth

Our minimum age for new trials is 7

Gender

Home Phone Number

Mobile Phone Number

Email Address

Retype Email Address

Address Line 1

Address Line 2

Address Line 3

Town/City

County

Postcode

Medical Details

Swimming Experience

Swims For Other Club

ASA Number

Please Select The Disciplines You Are Interested In

Masters

Swimming

Trial Requests - Additional Information

Please provide amplifying information in order that we have contact details for two adults who are parents, guardians or carers for swimmers under the age of 18. Additional contact information for each swimmer requires to be held so that the correct person(s) may be contacted in the event of an emergency or illness, or for the purposes of correspondence including pool closure or training session cancellation.

Parental Responsibility

As the primary contact listed above, do you have parental responsibility for the swimmer?

Swimmer Address

Does the swimmer normally live with you?

Additional Contact

Additional Contact - Name

Relationship to Swimmer

Additional Contact -Relationship To Swimmer

Home Phone Number

Additional Contact - Home Phone Number

Mobile Phone Number

Additional Contact - Mobile Phone Number

Additional Contact - Email Address

Confirm Email

Retype Additional Contact Email Address

Address Line 1

Additional Contact - Address Line 1

Address Line 2

Additional Contact - Address Line 2

Address Line 3

Additional Contact - Address Line 3

Town/City

Additional Contact - Town/City

Postcode

Additional Contact - Postcode

Parental Responsibility - Additional Contact

Does the additional contact person have parental responsibility for the swimmer?

Swimmer Address - Additional Contact

Does the swimmer normally live with the additional contact person?

Consent

Please confirm that you hold permission or consent to provide the personal information above.

Are You Human?

Swimmer is under 18