To book please complete the online form below and also pay the non-refundable deposit of £100 by debit/credit card by ringing the Mount Kelly Swim Centre on 01822 813170.

Easter balance must be paid by 28 Feb 2020
Summer Balance must be paid by 30 June 2020

If you book after the final balance dates then the you must pay the full course amount to secure your place.

Please tick which course(s) you would like to attend:

Child's Name

ACCOMMODATION

PERSONAL BEST TIMES

Swim groups for the week are allocated according to the times provided below. Please do provide times to ensure that your child is swimming with peers with similar ability.

Personal Best Time (in the format 1:11.11)

Personal Best Time (in the format 1:11.11)

MEDICAL INFORMATION

Doctors Address

Allergies

Marketing

CONSENT - I give consent for my child to participate in the following Swim School activities: Swimming, diving off blocks, ball sports, dodgeball, disco dancing, Gymnasium - including use of rowing machines, light kettle bells and TRX (Total Body Resistance Exercise) and a short walk into Tavistock town to visit the shops.

SIMPLY OUTDOORS
Your child has the option to take part in high ropes and/or archery at the on-site outdoor adventure centre, Simply Outdoors. High ropes and archery are activities with a danger of personal injury or death. Participants in these activities should be aware of and accept these risks and be responsible for their own actions.

DECLARATION

Mount Kelly or Simply Outdoors will not share any information or data collected with any third parties.

In my opinion, my child is fit and able to take part in the Swim School activities.

I give my consent to using over the counter products if required such as paracetamol, Strepsils, antihistamine or cough linctus, administered by Matrons or First Aiders.

I understand in an emergency every effort will be made to obtain consent for treatment, operation or anaesthetic, but if this proves impossible, I authorise the Head Coach, Swim School Matron or Simply Outdoors staff to act in loco-parentis.

A copy of the Mount Kelly and Simply Outdoors current Certificate of Public Liability Insurance can be provided upon request. Either company cannot accept liability arising from circumstances undisclosed in this Consent Form.

DIGITAL SIGNATURE


Please provide an email address where we can send a link to your current form.

Email Address :