Masters (18 years plus) "free swim" Trial Request Form

Full name of Swimmer:

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

Address:

Is this a Tower Hamlets Address?     Yes     No

E-mail Contact Address:

Telephone Contact Numbers:
Home: College/Work: Mobile:

College: Profession:

Do you suffer with either of the following: Diabetes or Epilepsy
Yes     No (Please state)

Do you have a Disability? Yes     No

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

Are you aware of any adaptations required? Please explain:

Are you currently a member of a swimming club? Yes     No
Have you been a member of a swimming club previously? Yes     No

Masters sessions are held on Tuesdays (Mile End L/C), Wednesdays and Fridays (York Hall L/C) from 19.30 - 21.00.

I understand:
That I will be contacted by e-mail or phone prior to commencing and notified of a date to attend.

I wish to attend for a trial on Friday / / (date)