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SWIMMER NO 1

Swimmmer's Name*

Sec Student*

Date of Birth*

SWIMMER NO 2

Swimmmer's Name

Sec Student

Date of Birth

SWIMMER NO 3

Swimmmer's Name

Sec Student

Date of Birth

PARENT'S DETAILS

Parent/ Guardian Name*

Address*

Email*

Phone Number*

Mobile*

Any medical conditions we should be aware of

Security Code

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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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