Happy Cubs

PICK POOL

Pick Class

Your name *

Address

Relationship to bear cub

Email address *

Phone number

Password *

Confirm Password *

Any medical conditions we should be aware of?

Yes

No

Medical information is kept strictly private & confidential

Bear cub's name (child)

Bear cub's date of birth

Bear cub's gender

Female

Male

Any medical conditions we should be aware of?

Yes

No

Medical information is kept strictly private & confidential

Name (other guardian)

Relationship to bear cub

Contact phone number

Address (if different to above)

Any other information you'd like us to know?

Where did you hear about Swim Cubs?

I confirm that I have read the Terms & Conditions, consent to same and warrant the information in this form is correct.

PICK POOL

Pick Class

Bear cub's name (child)

Bear cub's date of birth

Bear cub's gender

Female

Male

Any medical conditions we should be aware of?

Yes

No

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