Swimming Program Application Form

Trentham School Family: YESNO

Family Name: (required)

Address:

Phone:

Email:

Parent/Carer's Name: (required)

Date:

Does your child(ren) have any disabilities, medical conditions eg. Asthma, learning/behavioural issues that we should be aware of?
NOYES(please specify)

Please comment swimmer, non swimmer, and day/time preference: