Membership Application

1Members Details

2Emergency Contacts

3Photography Consent

4Swimmers Medical Declaration

5Agreement

Members Details

(ALL SECTIONS OF THE APPLICATION MUST BE COMPLETED)

(* = Required Fields.)

Please specify if a member of any other swimming club? *

Any Swim Club

Section applying to join:- *

(Please select from the dropdown list the section of the club you are interested in applying for.)

School *

(Please enter the school where your child studies.)

Swimming Ability ? *

Please give as much information above about your swimming ability as possible (certificates achieved, strokes, distances, times etc.)

(N.B. For Competitive Swimming there is a minimum swimming ability of Swim England Learn to Swim Stage 7, or equivalent, and you should be able to swim 250 metres continuously.)

Volunteer Role/Section *

(See Volunteers web page for details.)

Volunteer : - What is your Swimmers Name ? *

(Please note that different roles have different requirements and additional training will be given as appropriate – please respond to any emails regarding course availability as soon as possible so that spaces can be secured. If you will be helping directly with U18’s, the club will require that you have a DBS check and safeguarding training before you can help, you will be advised if this is required and will be contacted by our Welfare Officer.)

(Please note the following information will be held on a computer database.)

All of the following to be completed by the Member: (if under 18, then a Parent/Guardian)

(Please note the following information will be held on a computer database.)

All of the following to be completed by the Volunteer: (if under 18, then a Parent/Guardian)

Members Name (Swimmer) *

First

Last

Volunteers Name *

First

Last

Gender *

Male
Female

Address *

Postcode *

Date of Birth *

(Swimmers Date of Birth - Min Age to join is 7)

Date of Birth *

Home Telephone Number *

(If under 18 then please use the primary carer's details.)

Mobile Telephone Number - if this is the same as above please enter number again *

(If under 18 then please use the primary carer's details.)

Email *

Confirm Email

Please note that the Club uses email for all communications and an up-to-date email address is essential. Please DO NOT use a business/work address.

(If under 18 then please use the primary carer's details.)

Emergency Contacts

Primary Contact Name *

First

Last

Relationship to Member (Primary) *

Primary Mobile Number *

Primary Email Address *

Please note that the Club uses email for all communications and an up-to-date email address is essential. Please DO NOT use a business/work address.

Secondary Contact Name *

First

Last

Relationship to Member (Secondary) *

Secondary Mobile Number *

Secondary Email Address *

Please note that the Club uses email for all communications and an up-to-date email address is essential. Please DO NOT use a business/work address.

Parents/Guardians is your swimmer under 18 ? *

If so, please complete the following in respect of your child.

Photography Consent

Chelmsford City Swimming Club from time to time will film and photograph (both individually and in groups) swimmers under the age of 18, in line with both the Club and Swim England photographic policies. Photographs may be taken to use on the club’s website, social media, newspaper and other on-line articles, to use on club notice boards, for advertising and marketing purposes and video is used for training purposes.

Please discuss your choices with your swimmer as we do not wish the first time for them to be aware of them, is when they are asked to leave a group photo call, as consent is not held and this can often lead them to being upset.

You can update your consent to any of the above by emailing the Welfare Officer at any time.

As the Parent or Guardian of :- *

Photographic, Filiming and Social Media Consent Given *

Signed *

Please type your name where a signature is required.

Swimmers Medical Declaration

Following updated guidelines from the Swim England, all clubs are now asked to request up to date medical information for their swimmers, just in case you require any form of medical assistance when attending a teaching, training session or competition.
All information given will be treated with the utmost respect and will be kept confidential and will only be available to appropriate staff such as coaches, team managers and chaperones.

Family GP *

GP's Telephone Number *

Medical Treatment/Medication *

Do you / your child have any specific medical conditions requiring ongoing medical treatment and/or medication that we need to be aware of?

Do you take medication? *

(If 'Yes', please detail.)

Medication taken:-

Please ensure you / your child always brings this to the pool and onto poolisde if it is likely to be required i.e. asthma inhaler

Suffer from Asthma? *

Do you/your child suffer from Asthma?

Tetanus cover? *

Do you/your child have up to date tetanus cover?

Food, drug or other allergies? *

Do you/your child, have any food, drug or other allergies? If 'Yes' please detail.

Food/Drug/Other allergies:-

Disabilities? *

Do you/your child, suffer from any disabilities (physical, visual or hearing) or learning / recognised behavioural problems that could affect their behaviour whilst training or competing, i.e. ADHD? If 'Yes' please detail.

Disabilities:-

Other Issues/Information? *

Do you/your child have any other issues/information we need to know about? If 'Yes' please detail.

Other Issues/Information:-

It may be essential at some time for a Club Coach or Team Manager accompanying you/your son/daughter to have the necessary authority to obtain any urgent treatment which may be required whilst at a competition, training or a club organised trip with Chelmsford City Swimming Club.

Members Name authorised for medical treatment *

(Enter the Full Name of the person who is permitted to receive medical treatment or Members Name (if 18 and over) or the Volunteers.)

Medical Permission granted *

Permission Given

I being the parent or guardian of the above named child/I, 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 doctor's medical opinion, for any delay to be incurred by seeking my personal consent.

Signed *

Please type your name where a signature is required.

Agreement

Please read the following carefully. By submitting your membership application and making membership payments you are deemed as accepting all of the following.

(All of the documents mentioned (underlined) here can be viewed on the clubs website on the Club Documents & Policies page.)

I confirm my understanding and acceptance of the rules and responsibilities of Chelmsford City Swimming Club and understand that such rules (as amended from time to time) shall govern my membership of the Club.

1. As a member of Chelmsford City Swimming Club, I agree to abide by the rules of the club as written in the Club's Articles of Association, bye-laws, Anti-Bullying policy and all the codes of conduct that apply.

2. If as a parent you are signing this on behalf of an under 18 - I also agree to abide by the Parents Code of Conduct and all other codes and policies that apply.

3. I hereby give consent for my personal membership data, together with any records of my competitive performances to be kept on a computer, by personnel appointed by the club. Chelmsford City Swimming Club and Swim England will not share the data with any third party for marketing or commercial purposes.

4. I will allow the Club Officers to use my email for communications purposes only. This will only be shared with Swim England and Gala / Competition organisers as necessary. See the club’s Privacy Policy and Data Protection Policy and Swim England’s Privacy policies for full details.

5. If I decide to leave the club then I undertake to notify the club by email to the relevant membership secretary by the 15th of the same month, e.g. to leave on the 30th September notice must be received by email no later than the 15th September. If I notify the club after this date then no refund will be due for any payments made in the following months.

Agreements *

I have read and agree with the above.

Signed *

Please type your name where a signature is required.