New Swimmers Application – Electric Eels Swimming Club

New Swimmer Application

Details of the Swimmer OR Details of the Parent/ Guardian if the swimmer is under 18

First Name

Last Name

Gender

Date of Birth

Address

Address Line 1

City/ Town

Post Code

Contact Phone Number

Mobile Number (if different)

Additional Emergency Contact Number

Emergency Contact Email

Medical Conditions: Does the swimmer have any medical conditions or needs (including asthma) or have any allergies? If yes please provide details including regular medication taken. A Swim England Medical Registration form may need to be completed.

Additional Questions

Current Level of Swimming Ability

Further details of Swimming Ability

I give permission for my child to be touched

Yes

I give permission to Electric Eels to take a direct debit from my bank account for membership fees

Yes

I give consent that Electric Eels can claim Gift Aid on my annual subscription (I confirm I am a UK taxpayer)

Yes

Permission for use of Images of the Swimmer

We may take photographs of your child at the swimming club. We may use these images in our publicity material, or in other printed publications that we produce, as well as on our website or on display boards. We may submit photographs to local newspapers and swimming magazines. We may also make video recordings for use on the website and as an aid to training. From time to time, the club is visited by the media who will take photographs or film footage of a visiting dignitary or other high profile event.
Your child may appear in these Images, which may be published in local or national newspapers, or on televised news programmes. To comply with Swim England best practice we need your permission before we can photograph or make recordings of your child. Please answer questions 1 to 5 below, then sign and date the form where shown. Please note should you wish to do so you can withdraw your consent by writing to the club Welfare Officer at any time.

1. May we use your child's photograph in publicity material or other printed publications that we produce for promotional purposes, or on display boards?

Yes

2. May we use your child's image on the club website?

Yes

3. May we record your child's image on video?

Yes

4. Are you happy for images of your child to appear in print and digital and social media?

Yes

5. Are you happy for your child's name to appear in the above?

Yes

Terms & Conditions

I confirm that I have read and agree to abide by the Electric Eels Swimming Club Code of Conduct for Swimmers and Parents and the Club's Rules and Policies. I confirm my understanding and acceptance of the Codes of Conduct, Rules and Policies (as may be amended from time to time) and that such Codes, Rules and Policies shall govern my and my child's membership of the Club. I further acknowledge and accept the responsibilities of membership upon members as set out in the documents.

I hereby give permission for the Coach or other authorised person accompanying my child and/or myself while at or travelling with the Club to give immediate necessary medical or surgical treatment as directed by medical authorities.

I have read the Club Rules & Swimmers' Code of Conduct

PRINT NAME AS SIGNATURE

New Swimmer Application

Contact Us

Details of the Swimmer OR Details of the Parent/ Guardian if the swimmer is under 18

Additional Questions

Permission for use of Images of the Swimmer

Terms & Conditions