Application for admission to the small pool

Full name of Child:

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

Parent / Guardian Address:

Parent / Guardian E-mail:

Telephone (parent/guardian):
Home: Work: Mobile:

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:

I understand:
That my child will not be admitted until he / she is five years old or over.

That I will be contacted by e-mail or phone prior to my son / daughter commerncing and notified of a time / date / venue to attend.

You may put your child's name forward at any i.e (from age two). This will ensure that he / she can start as near to his / her fifth birthday as possible.