All Contact Forms

Free Trial Swim Form
Membership Form
Equipment Request Form
General Equiries Form
Testimonials Form
Welfare Officers Form

Please Click the buttons below to expand the forms…

Free Trial Swim Form

Please make sure you read this

Please remember that this is a trial swim which is held at:
Mitcham Leisure Centre (Canons) on Sunday afternoon from 4:00-5:00pm

It is an evaluation to see how strong and how safe a swimmer is and to what sessions will be suitable for the swimmer.

Most swimmers will start off at Mitcham until they are strong enough to attend other sessions.

Please complete all questions on the form below.

Once it has been completed & Submitted,
please ring Harry (Head coach) to arrange a trial date on 07956 588921
(Please don’t call in the evenings as he coach’s swimming every night. Thank you)

Merton Pisces Swimming Club
Trial Swim Form

Swimmers Details

Please enter the swimmers full name.(Required)

Please enter the swimmers date of birth. (Required)

Please enter the swimmers place of birth. (Required)

Male / Female / Other (Required)
MaleFemaleOther

What School does the swimmers attend? (Required)

Please enter your full address. (Required)

Please enter your postcode. (Required)

Please enter any other information you think we may require.

Is the swimmer under 18 year old?
YesNo

Parent / Guardian Details (Required)

Must be completed by all swimmers

Which responsible adult are you? (Required)

ParentGrandParentsStep ParentFoster ParentAdopted ParentsGuardiansAuntUncleSisterBrotherCousin

Parent or Guardians Full Name. (Required)

Please enter your Parent or Guardians Landline number. (Required)

Please enter your Parent or Guardians Mobile number. (Required)

Please enter your Parent or Guardians Email address. (Required)

Please note that the Club uses email for all communication and
an up to date email address is essential.

Parent or Guardians - Relationship to swimmer. (Required)

DaughterSonGrand DaughterGrand SonGuardianOther

Please enter your Parent or Guardians Full address. (Required)

Parent or Guardians - Please enter the Postcode. (Required)

Medical Details

Must be completed by everyone. (Required)

Does your child have any specific medical conditions requiring medical treatment and / or medication, or any difficulties your child may have such as Dyspraxia, Dyslexia, Autistic Spectrum Disorders or ADHD that the coaches should be aware of during the trial period?

YesNo

If yes, please give details

Swimming History

How far can you swim? (Required)

Not very far5 meters10 meters25 meters50 meters100 meters or more

What stroke(s) can you swim? (Required)

ButterflyBackstrokeBreaststrokeFreestyle

Where did you find us? (Required)

Google SearchBing SearchMobile searchSocial MediaFriendInformation BoardRecommendationAdvertisementOther

Are you currently in or have you left a swimming club?
Or have you been having lessons?

Coming from another Club?

What was your last club?

GLL LessonsMerton SwordfishWimbledon DolphinsKingston RoyalsCheam MarcudaSutton & CheamMitcham MarlinsOther Club

If you selected 'Other club', please fill in the name here.

Swim England Membership Number?
(If you have one?)

Date you left your last club?

Policies, Terms & Conditions, Rules & Regulations Constitution and Data Policy

The information is true and accurate to the best of my knowledge.
I accept the Terms & Conditions issued by Merton Pisces Swimming Club
I accept the Guidelines issued by Merton Pisces Swimming Club
I acknowledge the constitution of Merton Pisces Swimming Club.

Signature of Member (Required)

Date of Signature of Member (Required)

Please type your name where a signature is required and select the date

Signature of Parent / Guardian (Required):

Date of Signature of Parent / Guardian (Required)

Please type your name where a signature is required and select the date

For insurance purposes, by submitting this application form you / your swimmer will be registered as a temporary member for the trial swim only

Thank you

Membership Form

Please make sure you read the following documents:

MPSC Important Club Documents

Click any book to open

Please answer all the questions and provide as much information as possible.
All required questions must be answered or you can not submit the form.

Merton Pisces Swimming Club - Membership Form

Merton Pisces Swimming Club
Membership Form

Swimmers / Members Details

Please enter the Swimmers Full Name.(Required)

Please enter their Nickname or name you are known by?

Please enter the Swimmers date of birth. (Required)

Please enter the Swimmers place of birth. (Required)

Swimmers Gender (Required)
MaleFemaleOther

Please enter the Swimmers full address. (Required)

Please enter the Swimmers postcode. (Required)

Please enter the Swimmers School & Location (Required)

Please enter Swimmers Mobile number.
(Required, if you have one)

Please note that the Club uses this for emergencies only
E.g Lost on a trip or events

Please enter Swimmers email address.
(Required, if you have one)

Please note that the Club uses email for all communication and
an up to date email address is essential.

What Social Media the Swimmer uses? (Required)

FacebookInstagramMessengerSnapChatXYouTubeDiscordTikTokWhatsAppOther

Is the swimmer under 18 year old?

YesNo

Parent / Guardian Details Details (Required)

Must be completed by all swimmers

Parent or Guardians - Full Name. (Required)

Which responsible adult are you? (Required)

ParentStep ParentGrandparentFoster ParentAdopted ParentsGuardiansAuntUncleOther

Relationship to Swimmer? (Required)

DaughterSonGrand DaughterGrand SonGuardianAuntUncleFamily memberFriendCousinOther

Parent or Guardians - Please enter your landline number. (Required)

Parent or Guardians - Please enter your Mobile number. (Required)

Parent or Guardians - Please enter your email address. (Required)

Please note that the Club uses email for all communication and

an up to date email address is essential.

Parent or Guardians - Please enter your full address. (Required)

Parent or Guardians - Please enter the Postcode. (Required)

Emergency Contact

Must be completed by everyone
Someone other than the parent or guardian.

In the event of an emergency and if a parent can not be contacted, we will use these details.
Please notify this person that you have used their details.

Please enter Emergency Contacts name. (Required)

Please enter Emergency Contact Mobile number. (Required)

Please enter Emergency Contact Landline number. (Required)

Please enter Emergency Contact email address. (Required)

Please note that the Club uses email for all communication and

an up to date email address is essential.

Relationship to swimmer. (Required)

DaughterSonGrand DaughterGrand SonGuardianAuntUncleFamily memberFriendCousinOther

Please enter Emergency Contacts full address. (Required)

Please enter Emergency Contacts Postcode. (Required)

Emergency Contact - Please enter any other information you think we may require.

Doctors Details

Must be completed by everyone

Please Enter Doctors Full Name. (Required)

Please enter your Doctors landline number. (Required)

Please enter your Doctors Emergency number. (Required)

Please enter Doctors email address. (Required)

Please enter your Doctors full address. (Required)

Please enter the Doctors Postcode. (Required)

Please enter any other information you think we may require when contacting the Doctor.

Medical Details

Does the swimmer have any known breathing difficulties such as asthma, a chest infection or previously had pneumonia? (Required)

YesNoSometimes

If 'yes' or 'sometimes' to the above question,
please provide details.

Any specific medical conditions, current treatment, taking medication, ongoing condition? (Required)

YesNoSometimes

If 'yes' or 'sometimes' to the above question,
please provide details.

Any specific body function, medical, mental health, behavioural problem? (Required)

YesNoSometimes

If 'yes' or 'sometimes' to the above question,
please provide details.

Does the swimmer have any allergies? (Required)

YesNoSometimes

If 'yes' or 'sometimes' to the above question,
please provide details.

Any condition that may affect swimming -Dyspraxia, Dyslexia, Autistic Spectrum Disorders, ADHD? (Required)

YesNoSometimes

If yes to above please provide details.

Swimming Details

How far can you swim? (Required)

Not very far5 meters10 meters25 meters50 meters100 meters or more

What stroke(s) can you swim?(25m or more)(Required)

ButterflyBackstrokeBreaststrokeFreestyle

Where did you find us? (Required)

Google SearchAdvertisementResidents MagazineMobile searchSocial MediaFriendInformation BoardRecommendationMerton WebsiteOther

If you selected 'Other', please fill in the name here.

How long have you been swimming / having lessons? (Required)

What level swimming awards have you achieved?
NoneBronzeSilverGoldPlatinum

What level do you hope to achieve? (Required)
I just want to swimI don't want to competeI want to learn all the strokesI want to be the best I can beCountyRegionalNationalOlympicOther

What other sports clubs do you belong to? (Required)
Or please type 'None'

Are you currently (or were you recently) in a club or taking lessons?

Yes

Coming from another Club?

What was your last club?

GLL LessonsNuffield HealthMerton SwordfishWimbledon DolphinsKingston RoyalsCheam MarcudaSutton & CheamMitcham MarlinsOther Club

If you selected 'Other club', please fill in the name here.

Swim England Membership Number?

Date you left or are leaving your last club?

Is Merton Pisces SC the only swimming club you will belong to?
YesNo

If you selected 'No'- What other club are you a Member of?', please fill in the name here.

Permissions and agreements

All permissions that are granted will be within child safeguarding limits. At no time will the child's full name or identifying details be used with images or videos.

I give permission for my child's photos or videos to be used.
(according to club guidelines.)I give permission for my child to be filmed or photographed for training purposes.I give permission for my child to go on club trips, holidays & attend events.

All documents are available on the club website at
https://mertonpisces.co.uk/site/all-club-documents/

Club Guidelines, Terms & Conditions, Privacy Policies, Constitution and Data Policies

The information is true and accurate to the best of my knowledge. I accept the Terms & Conditions issued by Merton Pisces Swimming Club I accept the Guidelines issued by Merton Pisces Swimming Club I acknowledge the constitution of Merton Pisces Swimming Club.

By selecting the tick boxes and submitting the application button you are consenting to Merton Pisces Swimming Club holding your personal data and giving us permission to contact you or others on this form if required. I understand that Merton Pisces Swimming Club will only use personal data for the purpose of your child’s involvement in training, activities, or competitions.

I accept all Club Guidelines, Terms & Conditions, Privacy & Data Policies & Club Constitution issued by Merton Pisces Swimming Club, and I acknowledge that it is my responsibility to appraise myself of all the rules and regulations of Merton Pisces Swimming Club and confirm my understanding and acceptance that such rules (as amended from time to time) shall govern the membership of the Club. I further acknowledge and accept the responsibilities of membership upon members as set out in these rules.”

Declaration I, being the parent/guardian of the above-named child hereby consent to my child’s participation in club activities and to the use of this information by Merton Pisces Swimming Club for the protection and safeguarding of my child’s wellbeing.

I also give permission for the Head Coach, Coach, Teacher, or other Club Officer to give the immediate necessary authority on my behalf for any emergency dental, medical or surgical treatment recommended by competent medical authorities, where it would be contrary to my son’s / daughter’s / other's interest, in the doctor’s medical opinion, for any delay to be incurred by seeking my personal consent.

Signature of Member (Required)

Date of Signature of Member (Required)

Please type your name where a signature is required and select the date

Signature of Parent / Guardian (if swimmer is under 18 years)(Required)

Date of Signature of Parent / Guardian (Required)

Please type your name where a signature is required and select the date

Thank you

Equipment Request Form

Contact Form - Equipment Request Form

Required:Club Hat (Green or White), Club costume, Pullbouy - Float, Water Bottle, Fins

Please select your items:

Club Hoodie-(Small),	£25.00
Club Hoodie-(Medium),	£25.00
Club Hoodie-(Large),	£25.00
Girls Costume (24-32),	£25.00
Girls Costume (34-38),	£27.00
Boys Costume (24-28),	£26.00
Boys Costume (30-38),	£29.00
Fins (Size),	£26.00
Swimming Bag,	£25.00
T-bag Shirts,	£10.00
Pullboys Float,	£9.00
White Hat,	£3.00
Green Hat,	£6.00
Water Bottle,	£3.50
Bottle Top (Old),	£0.00

Selected Items:

Total:
£0.00

Please enter your full name (Required)

Please enter your child's full name (Required)

Please enter your email address (Required)

Please enter your phone number (Required)

Additional Information: (Required)

General Enquiries Form

Merton Pisces Swimming Club - General Enquiries Form

Merton Pisces Swimming Club
General Enquiries Form

Please do not use this form for Trial Swim requests,
Thank you

Please select a subject.

General EnquiryTransfer enquirySessionsInformationWebsite ProblemsOther

Please enter your name. (Required)

Please enter your child's name.

Please enter your email address. (Required)

Please enter you phone number. (Required)

Please enter your full address. (Required)

Please enter your postcode. (Required)

Where did you find us? (Required)

Google SearchBing SearchMobile searchSocial MediaFriendInformation BoardRecommendationPool FinderOther

Please provide any other information. (Required)

Thank you for contacting us, we will be in touch soon

Testimonials Form

Merton Pisces Swimming Club - Testimonials Form

Merton Pisces Swimming Club
Testimonials Form

Hi Welcome back,
Nice to see you again.

What made you come back to us?
(You can choose more that one item.)

TestimonialMessageJust a quick Hello!Remember Me?I was dreaming of the old days.Saw you on Social media.Just web browsing.Talking to a FriendAdvertisementInformation BoardOther

If social media or other, please select which ones.
(You can choose more that one item.)

FacebookMessengerInstagramYouTubeLinkedInXTikTokWhatsAppPinterestMerton WebsiteOther

Please enter Your name. (Required)

Please enter your phone number. (Optional)

Please enter your email address. (Required)

Leaving Date (Roughly) (Optional)

Can we use your message on our website?

Yes, you canNo, I rather you didn't.

Your message (Required)

Thank you for getting in contact, it means a lot to us.

Welfare Officer Form

Merton Pisces Swimming Club - Welfare Officers Form

Merton Pisces Swimming Club
Welfare Officers Form

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Most of these items are optional, but I will require a name and a way of contacting you.

Any information you enter here will be in the strictest confidence.

Please enter your full name (Required)

Please enter your email address (Required)

Please enter your phone number

What is the problem?

ConcernsBullyingIncidentAnxiousAngryHurtLonelySadUncomfortableUnsureWorried

Date it happened or started? (if this applies)

Any other information:

This information is accurate to the best of my knowledge

Thank you for filling this out.
I will be in touch as soon as possible

Club Constitution	Club Guidelines for membership	Club GDRP Privacy Policy
Club Terms & Conditions	Club Codes of Conduct	Club Privacy Policy