Online Membership Application

What is your full name? *
What is your home address? *
Are you male or female? *
What is your postcode? *
What is your date of birth? *
Is there a brother or sister already in the club? *	Yes No
Is there a brother or sister already on the waiting list (whether or not tried out) - please give their name or write NO *
What is your contact telephone number (landline preferred, please)
What is your email address (this will be our main way of contacting you)? *
Are you confident in the Main Pool? *	Yes No
Are you confident in deep water? *	Yes No
Can you put your face in the water, blow bubbles, jump in, walk round the pool without a float? *	Yes No
Are you a non-swimmer, beginner, improver or advanced swimmer? *
What is the longest distance that you can swim without getting tired - 1 length of main pool, 6 lengths, for instance? *
Do you have any National Plan for Teaching Swimming awards? If so, please give highest Level and date *
Do you have any Water Skills awards? If so, please give the highest grade and date
Do you have any Swimming Challenge awards? If so, please give highest level and date
Do you have any Diving Skills awards? If so, please give the highest level and date
Do you have any other swimming awards? Please give details
How did you hear about the Club? *
I acknowledge receipt of the Rules of the club (see the Club Rules webpage) and confirm my understanding and acceptance that such rules shall govern my membership of the Club. I acknowledge and accept the responsibilities of membership upon members as set out in these Rules. *	Yes No
I understand that subs must be up to date or in advance for me to take place in Clubs activities. I know that if my subs are 2 months behind, that the Club may give my/my childs place to someone else.	Yes No
Are you a member of any other swimming club? If so, please give details.
Do you have any medical conditions or disabilities that may affect you during your time with us, such as asthma, back problems, epilepsy, repeated ear infections, grommets, heart problems, lack of mobility in limbs or joints, breathing problems, hearing problems, etc? If so, please give details or write NA
Does your child have any learning difficulties at school, behavioural problems, autism, ADHD, hyperactivity, etc? If so, please give details or write NA
Remember that we actively promote children of REGULAR volunteers to the top of the waiting list! Do you have any skills that you might be able to offer us, contacts, knowledge, fundraising ideas or opportunities through employers, that might help us, even 10 minutes a week or on an occasional basis? If so please give details or if not, please write NA