Guildford City Application Form

Trial Application Form For New Members

PLEASE COMPLETE THIS FORM TO APPLY FOR A TRIAL WITH GUILDFORD CITY SWIMMING CLUB. IF YOU HAVE ALREADY COMPLETED A TRIAL AND YOUR APPLICATION TO JOIN THE CLUB HAS BEEN ACCEPTED PLEASE COMPLETE THE CLUB MEMBERSHIP FORM.

THIS FORM WILL BE AUTOMATICALLY EMAILED TO MEMBERSHIP ON CLICKING THE SUBMIT BUTTON.

For junior members (under the age of 18) this form must be completed by a parent.

ALL SECTIONS MUST BE COMPLETED ~ PLEASE TYPE YOUR NAME WHERE A SIGNATURE IS REQUIRED






Swimmers Details

Name of Swimmer

Date of Birth

Swimming Group
Please state the section of the club you are interested in applying for.

Address

Post Code

Your Email

Please note that the Club uses email for all communication and an up to date email address is essential.

Contact Phone No


Previous Club Members

Please complete this section if you/ your swimmer are currently a member of a swimming club affiliated to the ASA.

Club

A.S.A. Number


Academy Membership Applications

Please complete this section if your swimmer is applying to the Academy section of the club.
As well as information about any ASA awards or badges achieved please add any further information regarding their current ability, ie distances able to swim without being under duress and on which strokes.

A.S.A. Award/Badge Level

Swimming Distance


Parent / Guardian Details Details

Must be completed for all swimmers under 18.

Name

Relationship to swimmer

Address (if different from above)


Medical Details

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

Do you or you child have any specific medical conditions requiring medical treatment and / or medication, or any difficulties you or your child may have such as Dyspraxia, Dyslexia, Autistic Spectrum Disorders or ADHD that the coaches should be aware of during the trial period?

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 has completed the trial period and 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 if an application for ASA membership is made.

Signed (Swimmer)

Please type your name where a signature is required.

Date

Signature of Parent / Guardian (if swimmer is under 18 years)

Please type your name where a signature is required.

Print Full Name

Date


Please prove you are human

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IMPORTANT: HIGH PERFORMANCE & COMPETITIVE DEVELOPMENT TRIALLISTS ONLY

For insurance purposes, by submitting this application form you/ your swimmer will be registered as a temporary non-competitive category 1 member of the ASA through Guildford City. This registration will be cancelled immediately should the trial subsequently not result in the swimmer joining the club.