Daffodil Day 2025 : Register

Joining Team SS Coutabeans

First Name *

Last Name *

Email Address *

Password*

Mobile *

Year of Birth *

Fundraisers under 15 require parent or guardian permission. Please provide their details below or call 1300 65 65 85 for more info.

Parent / Guardian First Name *

Parent / Guardian Last Name *

Parent / Guardian Email Address *

Parent / Guardian Phone *

Please provide your address postal for your FREE swim cap and welcome pack. *

(enter manually)

Address Line 1 *

Address Line 2

Town/Suburb *

Postcode *

State *

Country *

You’ll also score an exclusive Daffodil Day Dip shirt if you raise $1,000 or more so please add your size below. *

How many time have you taken part in the Daffodil Day Dip? *

Are you fundraising in honour of anyone? *

Yes No