Diver membership form 2025
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Email *
First Name *
Surname *
Date of birth?  *
Gender / Identified as?
Home address?  *
Email address? (Parent/Guardian if under 16) *
Best contact number? (Parent/Guardian if under 16) *
Is this the only diving/swimming club that the diver is a member of? (If yes, please type in the Swim England membership number here)
 *
Parents / Guardians details and emergency contact information
Contact 1: Full name? *
Contact 1: Phone / Mobile? *
Contact 1: Email? *
Contact 1: Relationship to diver *
Contact 2: Full Name? *
Contact 2: Phone / Mobile? *
Contact 2: Email? *
Contact 2: Relationship to diver? *
Child's School borough (helpful for competitions going forward)
Please click on the club t-shirt size you require. Included in club membership fee. *
Medical Information
Family GP?
Family GP contact information?
Existing Medical conditions and any recent changes to medical conditions
Does your child have any specific medical conditions requiring medicinal treatment and/or medication? If so - please give details - incl. Dosage & frequency of any medication:
Does your child suffer from asthma & if so, are they registered with ASA as Asthmatic? If so - please provide information on any medication they may take:
Allergies
Does your child have any food, drug or other allergies? If so - please supply full details and any specific emergency treatment plan with this returned form:
Disabilities

Does your child suffer from any disabilities (Physical, visual or hearing) or learning . recognised behavioural problems that could affect their behaviour while training e.g. ADHD??

If so - please supply full details:


CONSENT ON DIGITAL CONTENT

The club may wish to take photographs or film individuals and groups of members under the age of 18 during their membership. All photographs and filming and all use of images will be in accordance with the Swim England Photography and Filming guidance and the clubs Privacy Policy. However, the club requires consent to take and use photographs. 

Parents/Guardians and individuals have a right to refuse agreement to their child being photographed. As the parent/guardian please indicate your permission below. Please note you can withdraw your consent at any time should you wish to do so. This must be done by writing to the club via email.

By signing and returning this form you are agreeing to Digital Images to be used by the club.


I give permission for photos to be taken of my child. *
DECLARATION

  1. To the best of my knowledge and belief, the information given above is complete and accurate.

  2. I undertake to keep the club informed of any changes that may arise in relation to the above information.

  3. It may be necessary at some time for the coaches or team management staff accompanying your child to have the necessary authority to obtain any urgent treatment which may be required. By signing the declaration below, you are giving consent for any medical or surgical treatment recommended by competent medical authorities, where it would be contrary to my sons/daughters interest, in the doctor’s medical opinion for any delay to be incurred by seeking my personal consent.

  4. I am aware of the type of activities likely to be undertaken & consent to my child taking part. I acknowledge that the division will be liable in the event of an accident only if they have failed to take reasonable steps in their duty of care for my child. I understand that the coaches have a common law duty to act in the capacity of a reasonable prudent parent.

  5. I am aware of the club's code of conduct & acknowledge the need for my child to abide by these conditions at all times. Failure to do so may result in sanctions being applied. In the event that such action involves expense, I accept responsibility to meet any such costs reasonably incurred.

By signing this form i agree to the declaration above *
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