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Winchester Waterpolo Club Membership Application Form
Please note - if you have a reservation about completing this this form, it is also available as a PDF that can be printed and returned to us at
winchesterwaterpolo@gmail.com
; however, it is our preference that parents use the online version of the form.
If you would prefer to provide a hardcopy of the form, the PDF can be downloaded from:
https://winchesterwaterpolo.com/downloads
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* Indicates required question
Full Name Of The Member (Player)
*
This is the players name, not the name of the parent / guardian (in the case of junior members).
Your answer
If you are completing this form on behalf of a child to whom you are a parent or guardian, please also provide your name too.
*
If you are over 18 and completing this form for yourself, please specify "N/A".
Your answer
Date of Birth
*
Of the person named in the first question on this form.
MM
/
DD
/
YYYY
Gender
*
Of the person named in the first question on this form.
Female
Male
Prefer not to say
Other:
Swim England Registration Number (if known)
Of the person named in the first question on this form. Leave blank if not currently registered with Swim England.
Your answer
Country of Representation (Required by Swim England):
*
Of the person named in the first question on this form.
England
Wales
Scotland
Northern Ireland
Other:
Any medical condition(s) that we should be aware of for the person named on the first question? Also, please add details of any medication taken (if applicable)
*
If applicable, please also include details of any medication taken too. Please specify "N/A" if not applicable.
Your answer
Any allergies that we should be aware of?
*
Applicable to the person named on the first question. If yes, do you carry an epi-pen? Please specify "N/A" if not applicable.
Your answer
Any disability we should be aware of?
*
Applicable to the person named on the first question. Please specify "N/A" if not applicable.
Your answer
Your postal Address
*
Including postcode
Your answer
Your Telephone Number
*
Mobile Number preferred.
Your answer
Your Email Address
*
Email will be the principle way that we will keep in touch with members.
Your answer
Details of a Primary Emergency Contact For the Player (named on the first question)
*
Please include Name, Telephone Number, Email address and the relationship to the person detailed above.
Your answer
Details of a Secondary Emergency Contact For the Player (named on the first question)
*
As above, please include Name, Telephone Number, Email address and the relationship to the person detailed above.
Your answer
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