Membership Form Share this! Facebook Twitter LinkedIn 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 onlyE.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 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 in or have you left a swimming club? Or have you been having lessons? No 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? Date you left 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 Δ
