ESS Regional Qualifier 2020
This entry form should only be used by Enfield Swim Squad members.

PAYMENT FOR GALA ENTRIES WILL BE TAKEN BY DIRECT DEBIT. IF YOU HAVE NOT YET SIGNED UP FOR THE ESS GALA DIRECT DEBIT SCHEME, PLEASE DO SO HERE: https://pay.gocardless.com/AL0000NJ5PHFXB.
Email address *
Swimmer's surname *
Please enter SURNAME as registered with Swim England.
Your answer
Swimmer's FIRST name *
Please enter FIRST name as registered with Swim England.
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Swim England Registration Number *
Go to www.swimmingresults.org/biogs to find your number and check your time.
Your answer
Contact Mobile Number *
Your answer
50m Free
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
100m Free
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
200m Free
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
400m Free
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
50m Back
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
100m Back
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
200m Back
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
50m Breast
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
100m Breast
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
200m Breast
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
50m Fly
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
100m Fly
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
200m Fly
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
200m IM
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
400m IM
If you wish to enter this event, please enter your time in the following format: MM:SS.HH (e.g. 05:23.09; where minutes are 0, enter '00' for MM, e.g. 00:31.65). If you do NOT wish to enter this event, please leave blank.
Your answer
Name of your squad: *
Key: PPE= Podium Performance, PPO= Podium Potential, AGPE= Age Group Performance, AGPO= Age Group Potential, JPE= Junior Performance, JPO= Junior Potential, DEV= Development, ACA= Academy, MAS= Masters, ACT= Active, CLUB= Club Squad.
Data Consent *
Enfield Swim Squad may share the data collected with our partner organisations Swim Enfield and British Swimming/Swim England for purposes strictly related to the organisation of this competition and the recording of results on British Swimming rankings. The data will not be passed on to any other third party for any other purpose. Please email galaentries@enfieldswimsquad.org to alert us of any change in the data you submit.
Required
I CERTIFY THAT ALL TIMES AND DATA ARE ACCURATE AT TIME OF SUBMISSION. I AUTHORISE ESS TO COLLECT THE RELEVANT EVENT ENTRY FEES VIA DIRECT DEBIT. *
Please see gala conditions for detail of entry fees. ESS will charge an additional £1 per swimmer to cover admin cost. IF YOU HAVE NOT YET SIGNED UP FOR THE ESS GALA DIRECT DEBIT SCHEME, PLEASE DO SO HERE: https://pay.gocardless.com/AL0000NJ5PHFXB.
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