Barracudas Synchronised Swimming Club Registration Form
*Please note that Constantia Virgin Active gym membership is required for all swimmers
PERSONAL INFORMATION
Information of registering swimmer
Surname *
Your answer
First Names *
Your answer
ID Number (If Available)
Your answer
DOB *
Your answer
Age *
Your answer
Cell Number (of swimmer) *
Your answer
Physical Address *
Your answer
Postal Address
Your answer
Email Address *
Your answer
Medical Aid *
Your answer
Medical Aid Number *
Your answer
Allergies and/or Medications (If Applicable)
Your answer
Medical Doctor
Please provide name and contact details
Your answer
School
Your answer
SSA Registration Number (If Available)
Parent/Guardian Information
The following is to be completed if the swimmer is under 18 years of age
Mother's Name & Surname *
Your answer
Occupation
Your answer
Work Address
Your answer
Mother's Cell Number *
Your answer
Mother's Email Address *
Your answer
Father's Name & Surname *
Your answer
Father's Cell Number *
Your answer
Father's Email Address *
Your answer
Occupation
Your answer
Work Address
Your answer
SIGNATURE *
Of registering swimmer unless under 18 years of age
Your answer
DATE *
MM
/
DD
/
YYYY
PRINT NAME *
Your answer
CAPACITY
Your answer
Submit
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