Swimmer Event Registration Form

2014 StASSA Trials Gala entry form
Please ensure you complete all field marked with *
(any problems please e-mail andrew_ellis@stassa.org.uk)
Swimmers Firstname*
Swimmers Surname*
Date of Birth*
DayMonthYear
Male/Female*
School year 2013/14*
School attending*
School not in list
Please confirm that the above swimmer is in current attendance at the above school*
Check box to confirm
Swim club (if any)
ASA Number (if known)
Parent/Guardian name*
E-Mail Address*
Phone number (no space)*
Select events entered with times:
Select events (all 50m)*
Freestyle (Front crawl)BreaststrokeButterflyBackstroke
Entry times (for events entered) - indicate distance if not 50m
Please submit below when completed entry form. You will then be taken to the entry payment page.
Should be Empty:

2014 StASSA Trials Gala entry form