Abilities Registration Form

Register for a Session

Whilst this is NOT a learn to swim experience, those with basic swimming ability are encouraged to come along & experience the joy of swimming at a relaxed club come’n’try event hosted by the club and venue with the support of dedicated coaches.

CENTRE LOCATION

Select your preferred Centre Location *

Immanuel Piranhas - Immanuel College Sports Centre, 32 Morphett Rd, Novar Gardens.MARION SC - SA Aquatic & Leisure Centre, 443 Morphett Road, Oaklands Park.STARplex - Trinity College Gawler, Alexander Ave, Evanston South.The ARC - 531 Lower North East Road, Campbelltown.

NEXT AVAILABLE SESSIONS

Upcoming Session - HOSTED BY: Flipper Academy

The ARC Campbelltown - 29 MARCH 2025 TIME: 1pm – 3pm

PARTICIPANT DETAILS

First Name *

Last Name *

Preferred Name

Date of Birth *

IMPAIRMENT TYPE *

PhysicalIntellectualVisualHearingTransplantPhysical & IntellectualNeurodevelopmental

Gender *

(M) Male(F) Female(X) Unspecified

English is a Second Language

YesNo

Ethnicity

ATSI

AboriginalTorres Strait IslanderNone of the Above

CAN THE SWIMMER DEMONSTRATE THE FOLLOWING TASKS

Freestyle *

YES NO

Backstroke *

YES NO

Breastroke *

YES NO

PARTICIPANT/GUARDIAN CONTACT DETAILS

Name *

Home Phone

Mobile Phone *

Email *

SIGNATURE

I confirm that above information I have provided is true, complete and accurate. *

I give permission to share this information with SwimmingSA to assist with pathway opportunities. *

Patient/ Guardian Signature

Draw signature|Type signatureClear

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