New Member Application Form

Name of Swimmer:

Date of Birth:

School:

Previous Club(s):

Any Highlights:

Aims and Ambitions:

Address:

Postcode:

Email:

Please note that the Club uses email to communicate with its members and an up to date email address is essential.
(This must include the email address of the person responsible for payment of fees)

Home Phone No:

Mobile:

Emergency Phone No:

(A further contact number of a person we can contact in an emergency is essential.)

MUST BE COMPLETED FOR ALL SWIMMERS UNDER 18.

Title:

Name:

Relationship to swimmer:

Address (if different from above):

To be completed by members 18 years or over, or by parents/carers of swimmers under 18 years. Please select Yes or No as appropriate and complete further details as necessary.

Do you or does your child have any specific medical conditions requiring medical treatment and/or medication?: Yes   No

If yes, please give details:

Do you or does your child have any allergies?: Yes   No

If yes, please give details:

Do you or does your child take any regular medication?: Yes   No

If yes, please give details:

Any other relevant information?: Yes   No

If yes, please give details:

I understand that, in compliance with the Data Protection Act 1998, all efforts will be made to ensure that this information is accurate, kept up to date and secure and that it is used only in connection with the purpose and activities of the club. Information will not be kept once a person is no longer a member of the club. The information will be disclosed only to those members of the club for whom it is appropriate and relevant officers of the Amateur Swimming Association or British Swimming.

Signed (Swimmer):

Date:

Signature of Parent/Carer (if the swimmer is under 18 years):

For Parents/Carers of Competitive Swimmers under 18 years

It may be essential at some time for the Club Coach or Team Manager accompanying your son/daughter to have the necessary authority to obtain any urgent treatment which may be required whilst at a competition with Guildford City Swimming Club.
Would you therefore please complete the details on this form and sign below to give your consent.

I, being the parent/carer of the above named child hereby give permission for the Coach or Team Manager to give the immediately necessary authority on my behalf for any medical or surgical treatment recommended by competent medical authorities, where it would be contrary to my son/daughter's interest, in the doctors medical opinion, for any delay to be incurred by seeking my personal consent.

Signature of Consent by Parent/Carer:

Print Full Name:

Date:

Guildford City Swimming Club may wish to take photographs, (individual and in groups) of swimmers under the age of 18. All photos will be taken and published in line with ASA policy.

Photographs may be taken to use on the club's secure website, to include with newspaper articles, to use on club notice boards or for video for training purposes. A professional photographer (suitably approved) may take photos at competitions attended.

Consent given?: Yes   No

Signed:

Dated: