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

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)

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)

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

No