Apply

Please fill in your details below and we’ll be in touch within 2 weeks to find out more about you and your swimming. If you are applying on behalf of someone aged under 18, please give your details, too, in section 4.

1 Swimmer’s Details

2 Impairment Details

3 Swimming Details

4 Applicant’s Details

Swimmer’s Details
Title
Name*
First Last
Email*
Telephone number*
Address*
House Name / Number Address Line 2 Town / City County Postcode Country
Gender*
Age*

Impairment Details
Primary impairment*
- Physical
- Visual
- Intellectual (IQ of 75 or below)
Details of impairment*

Applicant’s details
Complete this section only if you are applying on behalf of someone aged 18 or under.
Title
Name
First Last
Email
Telephone number
- I’m happy for Swim Wales to contact me via email with swimming information that may interest me. I understand that Swim Wales will never pass my details onto third parties.
Name
This field is for validation purposes and should be left unchanged.

Apply

Swimmer’s Details

Impairment Details

Where do you currently swim?

Applicant’s details