Para-Tracker ID form – Swim England

Para-Tracker ID form

Swimmer Details

Is the swimmer aged 18 or over? *

Yes
No

Name *

First

Last

Date of Birth *

Gender *

Male
Female
Other
Prefer Not To Say

You chose 'Other'. Please provide more detail. *

Is the swimmer's current gender identity different to the one they were born with? *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Telephone number *

Mobile

Email *

Primary Impairment *

Physical
Visual
Intellectual (IQ of 75 or below)

Impairment details (eg CP hemiplegia) *

you Impairment times

Parent / Guardian Details

Parent Name *

First

Last

Parent Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Parent Telephone *

Parent Mobile

Parent Email *

Swimming Information Ability

Please indicate your level of ability *

Learn to swim / Swim School
Club swimmer
Recreational swimmer

Location of Learn to Swim / Swim School

How many times a week do you swim?

Learn to Swim stage (if known)

Club name

How many sessions a week do you swim?

Roughly how many hours a week do you swim?

Where do you swim?

How many times a week do you swim?

Data Protection

Below you need to confirm that you have read the Swim England Data Protection Statement before sending the form. You can access the statement here. Please take time read it and then confirm you have read it by checking the box below.

Data Protection *

I have read the Data Protection Statement above (Please tick)

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