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.
Swimmer's Surname
Your answer
Swimmer's First Names
Your answer
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.
Your answer
Squad
Address
Your answer
Post Code
Your answer
Home Phone
Your answer
Mobile Phone
Your answer
Email Address
Your answer
Alternative Email Address
Your answer
Name of Emergency Contact 1
Your answer
Emergency Contact 1 Relationship to Swimmer
Telephone Number of Emergency Contact 1
Your answer
Name of Emergency Contact 2
Your answer
Emergency Contact 2 Relationship to Swimmer
Telephone Number of Emergency Contact 2
Your answer
Ethnic Origin
Please describe your ethnic origin. Leave blank if you prefer not to say.
Your answer
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”.
Your answer
Do you belong to any other swimming, diving or water polo club? If yes, please provide details:
Your answer
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
Your answer
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