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Lismore Diocesan Secondary Swimming - 400m Freestyle Event Application - 10th March 2016 Kempsey
This form is for the PARENTS of swimmers who wish to be considered for the Diocesan Junior, Intermediate or Senior 400m Freestyle events.
If your son/daughter is wishing to be considered, please complete the form below, print and hit SUBMIT no later than Wednesday, 2nd March 2016.

Late applications NOT accepted - no consideration will be given.

Please Note: Boys Junior, Intermediate and Senior 400m events will be combined into the one race (events 126-128). The same will apply to the girls (Events 61-63) due to time constraints on a very long program. Thus the purpose of this application – places are limited.

Your sport coordinator will be advised of successful and unsuccessful nominations by Thursday, 3rd March.

Swimmer's Surname *
First Name *
School *
Please indicate your school's town or suburb
Gender *
Date of Birth *
dd/mm/yyyy (NOT 2016)
Age Division *
Junior (12-14), Intermediate (15-16) or Senior (17+). Ages based on what age you turn in 2016.
Best 400m Freestyle Time *
MUST have been swum in 2015 or 2016
Name of Meet *
Please indicate the correct name for the swim meet at which this time was swum
Date Swum *
Please indicate the exact date of the swim meet at which the time above was swum.
Website Address *
Please indicate the best and EXACT website address for checking of this result.
Parent Home Phone *
Parent Mobile *
Parent Email *
Parent Confirmation *
Please only click YES below if the above information is correct and that you wish for your child to be considered to compete in the Lismore Diocesan Secondary Swimming 400m freestyle event at Kempsey onThursday, 10th March 2016 (and that you understand that we are limited by the number of lanes available for this event)
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