Summer Skills Camp

11th – 17th August 2019

This is a residential camp running at Bryanston School in Dorset.

Closing Date for applications 01 June 2019, together with a £50.00 DEPOSIT.

IMPORTANT: Payment details will be provided after completing this form.

Acceptance will be advised by June 2019.

For more infromation please email Paul Sartain on paul.sartain@btinternet.com or Neil Harper on neil.harper9999@gmail.com

Please scroll down to fill in the form on this page

Your name *

Male/Female * MaleFemale

Date of Birth: *

Club: *

Swim England No: *

Address: *

Phone: *

Email: *

Personal Best Times (converted to short course pool) - complete as much as possible:

Butterfly 50m:

Butterfly 100m:

Butterfly 200m:

Backstroke 50m:

Backstroke 100m:

Backstroke 200m:

Breaststroke 50m:

Breaststroke 100m:

Breaststroke 200m:

Freestyle 100m:

Ind. Medley 200m:

Number of pool training sessions per week:

Duration of Session(s):

Number of Land/Gym Training sessions per week:

Duration of Session(s):

Medical, Dietary & Emergency Contact Information

NHS No (if known):

Known allergies:

Any medical condition which has been experienced in the past 5 years:

If applicable, please state any specific action to be taken in the event of an emergency:

Any medication - if yes, please list dose and frequency (past 5 years):

Doctor/Surgery Name & phone (inc. area code):

If applicable, please state any specific dietary requirements:

Emergency Contact Name 1

Relationship

Phone

Emergency Contact Name 2

Relationship

Phone

I agree that I am happy for my son/daughter (if under 18yrs of age) to receive medical attention from the medical team. *

In case of emergencies I give permission for the medical team to act in loco parentis. *

I confirm Tetanus injections are up to date *

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