Donate a swim application form

Your name (required)

Number of people you would like to request a swim for: (required)

Your email address (required)

Your phone number (required)

Do you have any additional needs? e.g. do you require a disabled changing room or pool hoist to help you access the pool? We are happy to discuss these when we contact you or you can explain them here.

Do you have a preferred date that you would like to swim?

Please help us understand why your applying:

Improve my mental healthI can’t afford to go swimmingPrefer not to say