Trial Request

Swimmer Details

First Name

Known As

Last Name

Date of Birth

Gender

Please complete this extra information because the swimmer is under 18 - Phone number and email should also be for Primary Contact

Primary Contact Person

Relationship To Swimmer

Home Phone Number

Mobile Phone Number

Email Address

Retype Email Address

Address Line 1

Address Line 2

Address Line 3

Town/City

County

Postcode

Medical Details

Swimming Experience

Swims For Other Club

ASA Number

Please Select The Disciplines You Are Interested In

Masters

Open Water

Swimming

Learn to Swim

Are You Human?