Jazz Carlin Intensive Learn to Swim Camp, Non-Res

Ages 5-10

Monday 1st - Wednesday 3rd August 2022

This course is for children aged 5-10 years only.

Your Child's Details

First Namerequired

Surnamerequired

Age at time of courserequired

Please select how old your child will be on the first day of the course.

Date of Birthrequired

Please use this format: DD/MM/YYYY

Gender*

Male Female

Which stage is your child currently swimming at?required

If you would like to add any further information about your child's swim capability please enter it here:

Medical Information, AEN and Dietary Requirements

Disclosing this information assists us with staffing, grouping and ensuring the welfare of your child; it does not automatically exclude your child from a course. If we require further information we may contact you in confidence for further details.

In the event of an emergency staff will make every reasonable effort to contact a parent or legal guardian before permitting treatment to proceed as advised by the medical authorities present.

Please inform us immediately if any of this information changes after you have submitted your application form.

Does your child have any medical conditions?*

No Yes

If yes, please provide details belowrequired

Is your child currently taking any medication?*

No Yes

If yes, please state the name, dosage and medication to be administered belowrequired

Please note that all medication brought on campus must be given to the Course Leaders/Coaches upon arrival. For reasons of safety, there are strict regulations for the management of medicines. We are only able to accept responsibility for drugs licensed in the UK. Please do not send medicines with your child unless prescribed by a doctor.

Does your child receive additional support at school for additional educational needs including behavioural issues?*

No Yes

If yes, please provide details belowrequired

Does your child have any significant allergies (e.g. allergic to peanuts or pollen)? *

No Yes

If yes, please give the name(s) and details of any symptoms and any medication required belowrequired

Please note that all medication brought on campus must be given to the Course Leaders/Coaches upon arrival. For reasons of safety, there are strict regulations for the management of medicines. We are only able to accept responsibility for drugs licensed in the UK. Please do not send medicines with your child unless prescribed by a doctor.

Does your child carry an Epipen (Epinephrine)?*

No Yes

If yes, please ensure they bring two with them. One must be given to the Course Leaders/Coaches.

Does your child have any special dietary requirements (e.g. lactose free or vegan)?*

No Yes

If yes, please provide details belowrequired

Is there anything else that you think we need to be aware of?

Parent/Guardian Details

Titlerequired

First Namerequired

Surnamerequired

Relationship to Childrequired

Address Line 1required

Address Line 2

City/Town/Villagerequired

County

Post Coderequired

Country

Primary Telephone Numberrequired

Secondary Telephone Number

Emailrequired

Emergency Contact Information

Please provide us with two emergency contacts who must be contactable for the duration of the course.

Emergency Contact 1

Would you like to use the Parent/Guardian details listed above as Emergency Contact 1?

If yes, we will use the primary contact number listed as the emergency contact number.

Yes No

First Namerequired

Surnamerequired

Relationship to Childrequired

Emergency Contact Numberrequired

Emergency Contact 2

First Namerequired

Surnamerequired

Relationship to Childrequired

Emergency Contact Numberrequired

Terms & Conditions

All bookings are subject to the Sports & Activity Courses Terms and Conditions which can be viewed here

Terms & Conditions*

I understand and accept all Terms & Conditions

Course Payment

I agree to pay the total displayed below.

Total Amount Due

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