Home
Our Venue
Goodwood Hotel
Goodwood Customers
Enrolment
Contact/Info
Contact Us
Booking Terms
Certificate Request Form
Swim Medical Form
Home
Our Venue
Goodwood Hotel
Goodwood Customers
Enrolment
Contact/Info
Contact Us
Booking Terms
Certificate Request Form
Swim Medical Form
Swim Medical Form
Adult Name
*
First Name
Last Name
Swimmers Name
*
First Name
Last Name
Email Address
*
Telephone Number
*
Swimmers Age
Has the swimmer been diagnosed with Asthma?
*
YES
NO
Has the swimmer been diagnosed with Epilepsy
*
YES
NO
Has the swimmer been diagnosed with Diabetes?
*
YES
NO
Please give details of the above medical reasons or other conditions that may affect the swimmers ability
Thank you!
