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Merton Pisces Swimming Club

Membership Form

Please complete the whole form & Write clearly

Please enter the Members Full Name.(Required)

Please enter the Members date of birth. (Required)

Please enter the Members place of birth. (Required)

Male / Female (Required)
MaleFemaleOther

Please enter the Swimmers School.(Required)

Please enter your postcode. (Required)

Please enter your full address. (Required)

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 BoardRecommendationPool FinderOther

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 the swimmer under 18 year old? YesNo

Which responsable adult are you? (Required)
ParentStep ParentFoster ParentAdopted ParentsGuardiansAuntUncle

Parent or Guardians Full Name. (Required)  

Parent or Guardians - Relationship to swimmer. (Required)
DaughterSonGrand DaughterGrand SonGuardianOther

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.  

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

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

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

Medical conditions or treatment?

If yes, please give details:

As parent/guardian of …………   I am happy for you to:   (Please check the boxes)

☐  Use my child’s photo or video to be used on club website or on clubs social media platforms.

☐  To have photos to be included in newspaper articles or to be taken by professional photographer at events.

☐  Filming for training purposes

☐  The information is true and accurate to the best of my knowledge.

☐  I accept the Rules & Regulations issued by Merton Pisces Swimming Club & Associated bodies

☐  I accept the Terms & Conditions issued by Merton Pisces Swimming Club & Associated bodies

☐  I acknowledge receipt of the constitution of Merton Pisces Swimming Club and confirm my understanding and acceptance that such rules (as amended from time to time) shall govern my membership of the Club.

Swimmers Signature:

Date of consent:

Parents Signature:

Date of consent: