Register For Great Swim Local

First Name *

Last Name *

Email *

Password *

Confirm Password

Home Swim *

Postcode *

Mobile Telephone Number *

Home Phone Number

Gender

Male Female

Ethnicity

Disability

Date of birth *

In the past week, on how many days have you done a total of 30 min or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise and brisk walking or cycling for recreation or to get to and from places, but should not include housework or physical activity that may be part of your job *

Before registering for Great Swim Local, how long had it been since you last went swimming? *

Which, if any, of the following types of swimming activity had you taken part in before these sessions? (choose as many as apply): *

Lane swimming

Swimming classes/lessons

Swimming with children/teaching children to swim

General swimming (not in lanes)

Water fitness sessions (e.g. Aqua Aerobics)

Swimming outdoors

Other

None

Which of the reasons listed below, if any, describe your motivations for wanting to take part in Great Swim Local?

Emergency Contact Name *

Emergency Contact Number *

Alternative Contact Number

Emergency Contact Relationship to Swimmer *

I accept the Great Swim Local Terms & Conditions *

Yes No

I would like to receive SMS messages from Great Swim Local

Yes No

I would like to receive emails from Great Swim Local

Yes No

I would like to receive emails from Great Swim

Yes No

I would like to receive emails from Great Swim Partners

Yes No

I confirm that I have the ability to swim in open water *

Yes No

Customer Registration

Account Details

Personal Details

Swimming Ability

Emergency contact details

Acceptance