ESS Membership Form
ESS members and applicants for membership must complete this form in full. Some of the data collected will be forwarded to the ASA (Amateur Swimming Association) for the purposes of registration and insurance and will not be passed on to any other third party for any other purpose. Please notify the Club Committee of any change in circumstances relating to this renewal/application for membership. A new form must be submitted if any ptreviously provided details change.
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Swimmer's Surname *
Swimmer's First Names *
Date of Birth *
Please enter swimmer's date of birth in the format DD/MM/YYYY.
MM
/
DD
/
YYYY
Gender *
ASA Number *
Please enter your ASA membership number. If you do not know your ASA number, you can look it up here: https://www.swimmingresults.org/membershipcheck/. For new membership applications, please enter 000000.
Squad *
Address *
Post Code *
Home Phone *
Mobile Phone *
Email Address *
Alternative Email Address
Name of Emergency Contact 1 *
Emergency Contact 1 Relationship to Swimmer *
Telephone Number of Emergency Contact 1 *
Name of Emergency Contact 2 *
Emergency Contact 2 Relationship to Swimmer *
Telephone Number of Emergency Contact 2 *
Ethnic Origin
Please describe your ethnic origin. Leave blank if you prefer not to say.
Health & Fitness Declaration *
Required
Medical Conditions *
Please state any medical conditions that you think we should be aware of such as asthma, heart problems, ear problems, allergies etc., and any medication you are currently taking for these conditions. If none, please write “none”.
Required
Disabilities *
Please state if you have any disabilities that we should be aware of. If none, please write “none”.
Do you belong to any other swimming, diving or water polo club? If yes, please provide details:
Photography Declaration *
Parents/Guardians, please indicate below if you consent to ESS using photography and video clips of swimmers under 18 years of age in published materials (website, social media, print, etc.)
Team Travel *
Parents/Guardians, please indicate below if you give permission for swimmers under 18 years of age to travel by coach to away galas, under supervision of Coaches and Team Managers.
Club Rules, Code of Conduct and Equity Policy *
The rules of Enfield Swim Squad, codes of conduct and equity policy can be found here: http://www.enfieldswimsquad.org/about-us/documents-and-policies/ .
Required
2016 Membership *
The ESS Annual Membership Fee for 2016 must be paid by bank transfer to ESS, HSBC, sort code: 40-20-23, account number: 42006057. PLEASE NOTE CATEGORY 1 MEMBERSHIP IS FOR NON-COMPETING MEMBERS ONLY and may only apply in the case of some Masters, Club or Active Squad members. Members of ALL OTHER SQUADS MUST REGISTER AS CATEGORY 2 members. You will NOT be insured to enter any competitions under category 1 membership.
Required
Date Payment Made *
Please enter payment date in the format DD/MM/YYYY.
MM
/
DD
/
YYYY
Data Collection Declaration *
ESS will do all that we can to protect the information you have provided. All information will be held securely on docs.google.com in non-human readable format. The information provided on this form will only be shared with Administrators, Coaches and Team Managers of Enfield Swim Squad, and the Amateur Swimming Association, and will not be passed on to any other organisation for any purpose.
Name of Parent/Guardian if swimmer is under 18 years of age
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