Membership Form

SWIMMERS DETAILS
All fields require an answer due to our insurance affiliation with Swim England.

* Swimmer’s First Name:

* Swimmer’s Last Name:

* Swimmer’s Gender:
Please ChooseMaleFemalePrefer not to Say

* Date of Birth:

PARENT/CARER DETAILS

* What is your relationship to the child?

* Your First Name

* Your Last Name

* Address

* Post Code

* Home Phone Number

* Mobile Number

* Email Address

ADDITIONAL SUPPORT & MEDICAL INFORMATION

* Do we need to know anything to be able to provide additional support?

* Are there any medical conditions we need to know about?

EMERGENCY CONTACT DETAILS

* Emergency Contact 1

* Emergency Contact 2

PHOTOGRPAHY & VIDEO CONSENT
Child’s Consent Required if they are over 13 years of age.

I consent to the photographing, and or, videoing of my child, as part of their involvement in the club, and accept that the photo’s and, or, videos will only be used for the publicising and promoting of the club or sport, or as a coaching aid.

I acknowledge that I have read and agree to the rules of the club as printed on the website and accept that such rules shall govern my child’s membership of the club. I acknowledge and accept the responsibilities of membership upon members as set out in the rules. I understand that subscriptions must be up to date for my child to take part in club activities. If in arrears by two months or more the place may be allocated to someone else.

Data Protection Act. All information is confidential to the club committee & teachers. Your information is not passed to third parties. All information is destroyed when a member leaves the club or the application is withdrawn. Do you agree to us keeping your information on record? If you answer NO then unfortunately your application cannot be processed.

I accept the Broadstairs Swimming Club is a Teaching Club and I will endeavour to make sure my child attends regularly

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