Swimming Activities Forms - Rossendale Leisure Trust

Parent/Carer Name

First

Last

Parent/guardian information is required for swimmers under 18 years of age.

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Contact Phone Number

Do you consider the swimmer to have a disability?

Email of Birth

Medical Information

Name of Doctors Surgery

We may wish to send you marketing information which may be of interest to you. Please tick if you are happy to receive this information.
Rossendale Leisure Trust occasionally uses photography/videos for publicity. We would like your permission to photograph/film the swimmer for possible inclusion in our publications, website, and other promotional material. The images will remain property of Rossendale Leisure Trust. Please tick if you are happy for your child to be photographed/filmed during any of our activities.

Swimming Activities Booking Form