Swimming in Veldhoven

V.Z.V. Njord

Registration form trial lesson

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    I register for *:

    Maak een keuze uit onderstaande disciplines:

    Swimming workoutUnderwater hockeyWaterpolo/zwempolo (diploma's A-B-C vereist)Competition swimmingMastersSynchronized SwimmingSwimmingskills (certificates A-B-C required)

    Personal details

    Family name*

    Name*

    Day of birth (dd-mm-yyyy)*

    Gender*
    MaleFemale

    Address (street and house number) *

    Zipcode and city*

    Swimming certificates
    ABCSwimming skills 1,2,3EasyswimOther

    Waar zwemdiploma behaald*

    Phone number (parents)

    E-mail address (parents)

    Any details

    Agreement

    I agree that Njord can use my details for internal communication during my membership.

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