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* Child 1:   dob:
Child 2:  dob:
Child 3:  dob:
Child 4:  dob:
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Swimming Achievements to Date:
Name of Venue:
Week: Week 1 Week 2 Both
Time:
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Contact Details
PO BOX 79
Jolly Harbour
Antigua
West Indies
Cell:
+1 (268) 725 25 45
Office Tel/Facsimile:
+1 (268) 561 07 07
Telephone (UK):
+44 (0)8707 101012

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