Membership Application, please complete a form for each child in CAPITAL LETTERS

What is your name? *
What is your address *
What is your postcode *
What is your e-mail address (this is our main way of contacting you) *
What is your home phone number *
What relation are you to the child *
What is your child's first name *
What is your child's Surname *
Is your child Male or Female *
What is your child's date of birth
Is there a brother or sister already in the club, if so what is their name *
Is there a brother or sister already on the waiting list *	Yes No
If 'yes' what is their name
Is your child a beginner, improver or advanced swimmer *
Is your child confident in deep water if so what distance can he/she swim, 1 length, 6 lengths or more *
If your child is a beginner can he/she put their face in the water, jump in, blow bubbles walk around without a float *
If your child is an advanced swimmer has he/she any Water Skill awards and what Stage achieved, or any other awards *	Yes No
If 'yes' what are they
Is your or was your child a member of any other swimming club *	Yes No
If yes please name where and when
Does your child suffer from any medical conditions or disabilities that may effect them whilst with us such as, asthma, epilepsy, back problems, repeated ear infections, grommets, heart problems, lack of mobility in limbs or joints, breathing problems, hearing problems or any other conditions we should know about? *	Yes No
If yes, please list them. This information is required for insurance purposes
Does your child have any learning difficulties at school, any behavioural problems, autism, ADHD, hyperactivity etc *	Yes No
If 'yes' what are they
Remember we actively promote children of REGULAR volunteers to the top of the waiting list. We are always in need of teachers and various volunteers on the committee. See conditions on the website regarding volunteers before saying 'yes' *	Yes No
If yes, please list them
I acknowledge that I have read and agree to the rules of the club (see the Club Rules page on the web site) and accept that such rules shall govern my child's membership of the Club. I acknowledge and accept the responsibilities of membership upon members as set out in the rules. I understand that subscriptions must be up to date or in advance for my child to take part in Club activities. I know that if my 'subs' are 2 months or more in arrears that the Club may allocate the place to someone else *	Yes No
Have you applied previously for this child	Yes No
If yes, what date approx.
Where did you here about the club