ATHLETE INFORMATION

Start Date:_____________________________

Last Name:_____________________________________________

First Name:_____________________________________________

DOB:_____________________ Nationality:___________________

Address:______________________________________________________________

_____________________________________________________________________ _____________________________________________________________________

E-Mail:____________________________

Medical Information: This information is only necessary if an athlete has a recurring problem you may feel is necessary for us to be aware of:

Parent (s) / Guardian Information:

Name:_______________________________________________________________

Address:______________________________________________________________

Mobile No:_____________________Home:_________________________________

Name:_______________________________________________________________

Address:______________________________________________________________

Mobile No:______________________Home:________________________________

Emergency Contact:

Name:__________________________________Relation to you_________________

Phone Number:________________________________________________________

All information is confidential to the club and where necessary to the Irish Swimming Authority.