Swimmers Full Name

Preferred Name

Age

Date of Birth

Racial Origin

Languages

Religion

Swimmers history and brief details of ability:

Does your child use arm bands Yes/NoYesNo
Can your child swim 5 meter Frontcrawl Yes/NoYesNo
Can your child swim 5 meter Backstroke Yes/NoYesNo

Does your child have any swimming awards: if so please list most recent and date archived
Other important information we may need to know i.e. medical, SEN, Speech and Language

Contact Address

Postcode

Home Telephone

Parent 1 Mobile number

Parent 2 Mobile number

Email
Parent/Legal Guardians
Please Provide an Emergency Contact Name & Number Other Than Yourself:

I have booked a time and day already booked Please State Time | Day | Pool.

I would like my child to be placed on waiting list for the next term please state which day and time you. Day of lessons | Time of lesson.

Preferred pool please tick.

Tuesday, Wednesday, Thursday or Sunday Quainton Hall School Harrow HA1 1RXSaturday Merchant Taylor School Sandy Lane, Northwood HA6 2HTno preference

(Please see timetables for pool times. Please do not contact any of the schools as STSS LTD is a separate enterprise).

We will do our best to get you booked in to your chosen time, if we cannot we will offer another day and time if available.

*Please return to: Splash Time Swim School F.A.O ‘Lucy Marett 214A Herlwyn Avenue Ruislip HA4 6HJ’ Your personal details will not be passed to any other organisation, but may be used by us to inform you of offers and services please ✓ the box if you don’t wish to receive information on our services and offers