Membership Form

Swimmers Details

Please enter the swimmer’s (your) full legal name as on the birth certificate.

Title of Swimmer

First Name of Swimmer (required)

Middle Name(s) of Swimmer (required)

Surname of Swimmer (required)

If the swimmer (you) prefers to be known by a different name please enter it here.

Preferred Name of Swimmer

Date of Birth (required)

Please confirm year of birth – format yyyy (required)

Gender (required)

Please enter as appropriate ie. Male/ Female / Prefer Not to Say /Prefer to Self-describe:

Ethnicity (required) ie. White British/Mixed White & Asian/Black Caribbean etc.

Swimming Group

If you are new to the club, please enter the swimming group you have been accepted for.

School (required)

Please enter the school where your child studies or n/a if you are over school age.

Aims & Ambitions

Address (required)

Post Code (required)

Your Email (required)

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

2 Emergency Contacts & Phone Nos (required) Please complete all 4 boxes.

Two further contact numbers of a people we can contact in an emergency are essential.

Please tell us how you heard about the swimming opportunities at Guildford City Swimming Club (required)

Country Of International Representation

Competitive Swimmers Only

Category

For the purpose of Competition either Open or Female

Previous Club Members

Highlights

Have you or your swimmers belonged to another Swimming Club? If yes, please give details of the last 3 clubs including dates and reason for leaving (if you have had any disputes or disagreements with any teachers/coaches/volunteers or Committee members at the Club that may affect a reference being submitted please ensure that this is recorded below even if this is not your reason for leaving):

Club

From/To

Reason for Leaving

Club

From/To

Reason for Leaving

Club

From/To

Reason for Leaving

Have you or anyone wishing to be a member of Guildford City been subject to an ASA judicial review?

YesNo

Negative answers do not necessarily mean that membership will be declined.

Membership of Guildford City will rely on various checks being undertaken. It is therefore important that questions are answered as accurately as possible. If at a later date undisclosed information comes to light the club reserves the right to rescind membership.

Parent / Guardian Details Details

Must be completed for all swimmers under 18.

Title

First Name

Surname

Date of Birth

Please confirm year of birth – format yyyy

A parent’s date of birth is now a requirement from the ASA.

Relationship to swimmer

Swim England Membership Number

If already a member

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.

Does the swimmer have any specific medical conditions requiring medical treatment and / or medication?
YesNo
If yes, please give details

Does the swimmer have any allergies?
YesNo
If yes, please give details

Does the swimmer take any regular medication?
YesNo
If yes, please give details

Any other relevant information? Please also give details of difficulties the swimmer may have that may affect swimming such as Dyspraxia, Dyslexia, Autistic Spectrum Disorders or ADHD.
YesNo
If yes, please give details

Swimmer’s Doctor & Surgery (required)

Doctor’s Tel. Number (required)

Data Protection Act – Privacy Policy

In compliance with the General Data Protection Regulation 25 May 2018, we will ensure that all information held by the club is accurate, kept up to date and secure and that it is used only in connection with the purpose and activities. We will hold the data for 3 years after your last contact or from when you leave the club and then any information will be destroyed.

For Members of the Club only, information will be disclosed to those members of the Club / Swim England for whom it is appropriate and necessary.

For Members, who in addition are Surrey University students and part of Team Surrey / University of Surrey Swim Team, information will also be disclosed to these organisations as appropriate and necessary.

Swimming England has registered with Data Protection on behalf of member Clubs, counties and regions, enabling them to hold personal data of members etc.

Records are kept on computer / Icloud platforms. Keeping information in this way enables us to run the club more efficiently.
By pressing the ‘submit application’ button you are consenting to Guildford City SC holding your personal data for the purposes of this application as set out above and to give us permission to contact you. A copy of Guildford City Swimming Club’s Privacy Policy is available from the Website under, About Us, Documents.

You can request information is deleted before the 3 years by contacting liz.simmons@gcsc.co.uk

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.

For Parents / Guardians 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, on the doctors medical opinion, for any delay to be incurred by seeking my personal consent.

Signature of Consent by Parent / Carer

Please type your name where a signature is required.

Print Full Name

Date

Parent’s Photography Consent

The Club may wish to take photographs of individuals and groups of swimmers under the age of 18 which may include your swimmer. All photographs will be taken and published in line with the Swim England Photography Policy. The club requires parental consent to take and use photographs. Parents have a right to refuse agreement to their swimmer being photographed. As the parent or carer please indicate your permission below. Please note you can withdraw your consent in writing to the Club Membership Administrator at any time should you wish to do so.

Photos to be used on club (secure) website? Yes/No
YesNo

Photos to be included in newspaper articles? Yes/No
YesNo

Photos taken by professional photographer at events? Yes/No
YesNo

Filming for training purposes? Yes/No
YesNo

Signed

Please type your name where a signature is required.

Date

Club Constitution and Conditions of Membership

As a member of Guildford City Swimming Club:

• You accept all the terms stated in this form.
  The Club has adopted the ASA Wavepower Documents for Safeguarding children and all the Codes of Conduct therein along with ASA policies. By sending this form you agree to read and be bound to the Wavepower document, Codes of Conduct and policies which can be found on the Club/ASA website. Other documents which members must read and agree to are available on our website under “About us – documentation”.
  

• You accept that once the swimmer enters the water each term the full fees are due regardless of how often they swim.

• You ensure that all fees and increments for the term are paid by the Payment Due Date on the invoice.

• You supply up to date contact details as requested to the Membership Team (the Club uses email to disseminate information).

Application for Membership

• I have no objection to information regarding me and / or my children being kept on computer.

• I agree to all the conditions of membership as outlined on this form and acknowledge that each time the swimmer enters the water it is also deemed that I have accepted any changes notifed my email, website or notice board.

Swimmer’s Name / Parent’s Name

Signature

Please type your name where a signature is required.

Date

If you are a UK taxpayer please consider completing our Gift Aid form after submitting this form. Link is at the top of the page. Many thanks.

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