About the Swimmer

About the swimmer

Name:
Age:
under 18  26-35  46-55  61-65  76+ 
18-25  36-45  56-60  66-75  Prefer not to say 
Email address (if swimmer is over 18):
Phone number (if swimmer is over 18):
Parent/carer details (if swimmer under 18):
Name:
Relationship to swimmer:
Phone number:
Email address:
Emergency contact details:
Name:
Relationship to swimmer:
Phone number:
Gender (Please tick ONE below):
Male  Female Trans*  Other  Prefer not to say 
District(Please tick ONE below):
Ashford /  / Gravesham /  / Shepway /  / Tunbridge Wells / 
Canterbury /  / Maidstone /  / Swale / 
Dartford /  / Medway /  / Thanet / 
Dover /  / Sevenoaks /  / Tonbridge and Malling / 
Ethnicity:
White / Mixed / Asian or Asian British / Black or Black British
 / British /  / White and Black Caribbean /  / Indian /  / Caribbean
 / Irish /  / White and Black African /  / Pakistani /  / African
 / Gypsy/Roma /  / White and Asian /  / Bangladeshi /  / Other*
 / Irish Traveller /  / Other* /  / Other*
 / Other* /  / Arab /  / Chinese /  / I prefer not to say
*Other ethnic group – if your ethnic group is not specified in the list, please describe it here:
Disability - You may have more than one type of impairment, so please select all the impairments that apply to you. If none of these applies to you, please select Other, and write in the type of impairment you have:
Physical impairment  Sensory impairment (hearing, sight or both) 
Mental Health condition  Learning disability  I prefer not to say 
Please specify:
Long standing illness or health condition, such as cancer, HIV/AIDS, heart disease, diabetes or epilepsy 
Other, please specify:
Do you need any specific individual support when swimming (if yes please specify what kind of support)?
Yes  No  ______
______
Are there any other individual considerations the Coach should be aware of when you are training?
______

Page 1 of 2