Contact, Medical Form and Consent Form






    Guildford City Swimming Club – Contact and Medical Form and Consent Form


    Swimming Camp 14th to 21st February 2025 – Fuerteventura


    To be completed by members aged 18 years or over, or by parents of members under 18 years – Separate forms should be completed for each swimmer.
    Please complete each box as requested.

    Full Name of swimmer as on passport

    Swimmer’s Date of birth

    Swimmer’s ASA Membership Number

    Swimmer’s Age as at 14.02.2025

    Swimmer’s Full Postal Address

    Swimmer’s Mobile Number

    1. Emergency Parent Name & Mobile

    2. Emergency Parent Name & Mobile

    Swimmer’s Dietary Information

    If not applicable type N/A.
    Please give any dietary information that your swimmer may have below. :

    Swimmer’s Medical Information

    If not applicable type N/A.
    PLEASE ENSURE YOU HAVE TAKEN OUT YOUR OWN ADEQUATE INSURANCE FOR ANY CURRENT MEDICAL CONDITIONS AND INJURIES AS OUR INSURANCE ONLY COVERS BASICS
    Please detail below any medical information that our organisation needs to know. Such as allergies, medical conditions e.g. asthma, diabetes, epilepsy, orthopaedic problems, or any injuries. Our insurance company requires full disclosure.

    Swimmer’s Medication

    If not applicable type N/A.
    Please ensure that any medication that you need to take during the camp is listed below. Any medication that you need to carry on your person is your responsibility. It is parent’s responsibility to check with Easy Jet about any restrictions/rules re carrying and packing medication etc.

    Carrying any Medication

    If not applicable type N/A.
    Please state below whether the swimmer will be administering their own medication or whether a Team Managers will need to do this. Where the Team Manager has to distribute the medication, please ensure that the exact dosage and frequency is given below for each medication. Any changes can be updated nearer the Camp date.

    Name of Doctor and Surgery Address

    Doctor’s phone number

    To be submitted by parent of members under 18 years. Swimmers over 18 can submit the form themselves.


    I UNDERSTAND THAT I MUST NOW HAVE IN PLACE CANCELLATION INSURANCE FOR MYSELF (IF A SWIMMER AGED OVER 18) / OR FOR MY SWIMMER(S) (IF UNDER 18) IN CASE THE CAMP IS CANCELLED FOR ANY REASON. PLEASE ENSURE THAT YOUR INSURANCE INCLUDES CANCELLATION AS SHOWN BELOW, THIS LIST IS NOT EXHAUSTIVE.
    • AIRLINE CANCELS FLIGHTS.
    • RESORT CANCELS CAMP.
    • ANY MEDICAL CANCELLATION

    By entering your name below, you are electronically signing this form.

    NAME:

    I understand that, in compliance with the Data Protection Act 2018, all efforts will be made to ensure that this information is kept secure and that it is used only in connection with the purpose and activities of the event/organisation. The information will be disclosed only to those members of the Club (Swim England), medical professionals or companies associated with the camp for whom it is appropriate and relevant.

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