Improver Trial Request Form

Full name of Swimmer:

Male:      Female:      D.O.B.: / /

Address:

Is this a Tower Hamlets Address?     Yes     No

School: College:

Is your child's school/college based within Tower Hamlets? Yes     No

Does your child suffer with either of the following: Diabetes or Epilepsy
Yes     No (Please state)

Does your child have a Disability? Yes     No

If yes:
Are there any access issues? Please explain:

Are you aware of any adaptations required? Please explain:

Full name of Parent/ Guardian: (Required for all swimmers under 18 years of age)

Parent/Guardian E-mail:

Parent/Guardian Telephone:
Home: Work: Mobile:

Is your child currently a member of any other swimming club? Yes     No
Has your child been a member of a swimming club previously? Yes     No

Trials are held on Fridays at 19.00 at York Hall Baths.
I wish to attend for a trial on Friday / / (date)