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SWIMMER NO 1

Swimmmer's Name*

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SWIMMER NO 2

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Date of Birth

SWIMMER NO 3

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Date of Birth

PARENT'S DETAILS

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Home of CYMS St Edmund's Swim Club

Visiting Address: 16 Mary Street, Woodend,
Ipswich, QLD 4305
Phone: 0421 600 812
Email: swimming@sec.qld.edu.au

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