Limerick Performance Centre Application Form
Please complete the following application form to apply for a place at the Limerick Performance Centre 2013/2014
* Required
Name of Applicant:
*
This is a required question
Date of Birth:
*
Month
January
February
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September
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Please tick below which type of membership you wish to apply for:
*
Limerick Performance Centre Full Time Programme
Limerick Performance Centre Trainability Programme (Part-Time)
This is a required question
Are you currently a member of the Limerick Performance Centre?
*
Yes
No
This is a required question
Have you paid for membership to the programme for this season?
*
Yes
No
Not ApplicableĀ
This is a required question
If you are applying for the Limerick Performance Centre Trainability Squad please indicate which training sessions you will be availing of:
Saturday PM and Wednesday AM are now full (updated September 20th @ 09:00am)
Monday AM
Tuesday AM
Thursday AM
Friday AM
This is a required question
Contact Email Address:
*
If applicant is under 18 please include parent/guardian email address
This is a required question
Home Address
*
This is a required question
Club Information
Current Club:
*
This is a required question
Club Coach Name
*
This is a required question
Club Coach Email Address
*
This is a required question
Swimming Background
Main Event:
*
This is a required question
Personal Best Time for this Event(s):
*
This is a required question
Have you qualified for the National Squads Programme for the coming season?
*
Yes
No
This is a required question
Education Information
Please indicate the level of education/employment in which you will be commencing from September 1st 2013
*
Primary School
Secondary School
Third Level
Part-Time Employment
Full-Time Employment
Other:
This is a required question
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