Brighton LSC New Nipper Request
Please fill out your details to register for the 2018/2019 season waitlist. Once the program is finalised, you will be contacted if your request has been successful. Please note, there are strict limitations on group numbers and not all New Nipper Request will be successful.
1st Child's Full Name *
Your answer
1st Child's Gender *
1st Child's Date of Birth *
MM
/
DD
/
YYYY
2nd Child's Name
Your answer
2nd Child's Gender
2nd Child's Date of Birth
MM
/
DD
/
YYYY
3rd Child's Name
Your answer
3rd Child's Gender
3rd Child's Date of Birth
MM
/
DD
/
YYYY
Guardian's Full Name *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Session Time Preference*
Please note we cannot guarantee that we can give you your preferred time but we will endeavour to accommodate all requests
School Child is attending
If there are children from the same school we will try and group them together
Your answer
Has your child ever joined another Life Saving Club
If you have joined another club previously we will need to request a transfer of club
Name of Previous Life Saving Club
Your answer
If you have friends that are currently enrolled or are joining this season please let us know below and we will try and put them together if possible
Your answer
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