Enrol

Swimit Enrolment form. One per Swimmer.

Swimmer Name*
Date of Birth*
MM slash DD slash YYYY
Gender*
- Male
- Female
Squad*
Swimmer Email address
Allergies/Medical requirements:
Parent/Guardian/Emergency Contact
Contact Name*
Relationship to swimmer*
Contact Phone Number*
Contact email (for squad information and coaching fee distributions)*
Address
Street Address City State Postcode Country
I would like to pay
- Monthly
- Quarterly
Squad (Monthly)
Squad (Quarterly)
Total
$ 0.00
Credit Card
Card Details
Cardholder Name
Memership confirmation*
I am a financial member of Riverside Swimming Club.
Comments
This field is for validation purposes and should be left unchanged.