Registration

Group Name: ………………………………………………….

Address: ………………………………………………………..

……………………………………………………………………..

Telephone: …………………………………………………….

No Name M/F Age Special Information
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Please print this form, complete it clearly and return to:

Baltinglass OEC,
Weavers Square,
Baltinglass,
Co Wicklow.

Names will be checked on arrival against the group members present and the group leader & centre instructor will sign to ensure accuracy.

Special information includes: Non-swimmers, special diet, medical information.

The Management /VEC will not be responsible for the loss of or damage to any valuables or property.

I certify that this is a true and accurate record of my group. (to be signed on arrival)

Signed: ……………………………………………………….. Group Leader

Checked: ……………………………………………………. Instructor

Date: ………………………………………………………….

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