Membership Application

Swimmer Details

Swimmer: Surname

Swimmer: First Name

Swimmer: Middle Names

Swimmer: Date of Birth

Swimmer: Ethnicity

Swimmer: Gender

Swimmer: Home Phone

Swimmer: Mobile Phone

Swimmer: Street Address

Swimmer: Suburb

Swimmer: City

Swimmer: Postcode

Swimmer: Email

Parent/Caregiver 1 Details

Parent/Caregiver 1: Surname

Parent/Caregiver 1: First Name

Parent/Caregiver 1: Middle Names

Parent/Caregiver 1: Postcode

Parent/Caregiver 1: Date of Birth

Parent/Caregiver 1: Ethnicity

Parent/Caregiver 1: Gender

Parent/Caregiver 1: Street Address

Parent/Caregiver 1: Suburb

Parent/Caregiver 1: City

Parent/Caregiver 1: Home Phone

Parent/Caregiver 1: Work Phone

Parent/Caregiver 1: Mobile Phone

Parent/Caregiver 1: Employer

Parent/Caregiver 1: Email

Parent/Caregiver 2 Details

Parent/Caregiver 2: First Name

Parent/Caregiver 2: Middle Names

Parent/Caregiver 2: Surname

Parent/Caregiver 2: Date of Birth

Parent/Caregiver 2: Ethnicity

Parent/Caregiver 2: Gender

Parent/Caregiver 2: Street Address

Parent/Caregiver 2: Suburb

Parent/Caregiver 2: City

Parent/Caregiver 2: Postcode

Parent/Caregiver 2: Home Phone

Parent/Caregiver 2: Work Phone

Parent/Caregiver 2: Mobile Phone

Parent/Caregiver 2: Employer

Parent/Caregiver 2: Email

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Address

Thank you for applying to Vikings. We will be in touch shortly.

Vikings Swim Club

218a Main South Road, Sockburn, Christchurch 8042

General Enquiry: Hello@vikingsswimclub.co.nz
Head Coach: George.L@vikingsswimclub.co.nz
Assistant Coach: Hannah.S@vikingsswimclub.co.nz