Coalville Swimming Club Membership Renewal Form 2020
We are very pleased to welcome you to Coalville Swimming Club. To ensure we have the correct details for you, please fill out this form to provide our Membership Secretary with the details we need.

If you are under 16, your parent or carer need to give their consent below as part of completing this form.
Email address *
Swimmers surname: *
Your answer
Swimmers first name *
Your answer
Swimmers address including postcode *
Your answer
Swimmers date of birth *
MM
/
DD
/
YYYY
Home telephone number *
Your answer
Contact mobile phone number *
The mobile number should not be that of a child as this could make the child vulnerable. For a child/young person these details should be those of the parent/carer. Please indicate next to the number the name of the parent/carer it belongs to.
Your answer
Additional contact email address
Neither the email address given above or this additional one should be that of a child as this could make the child vulnerable. For a child/young person these details should be those of the parent/carer.
Your answer
Do you consider yourself to have a disability? *
The Disability Discrimination Act 1995 defines a disabled person as anyone with "a physical disability or mental impairment, which has a substantial long term adverse effect on his or her ability to carry out normal day-to-day activities".
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