Club Organiser | Form Display

Swimmer's First Name

Swimmer's Last Name

Swimmer's Date of Birth

Swimmer's Birth Sex

Agree to Publicity

Address Line 1

Town

County

Postcode

Email Address (Main)

Mobile Phone No.

Specific Medical Details

Consent to store/use your data

Photography and Video Consent

The Club may wish to take photographs of individuals and groups of Divers which may include you (or your child). All photographs that are taken and published will be done so in line with the Swim England Photography Policy. The Club requires consent to take and use photographs. You have a right to refuse agreement to you or your child being photographed. Please note, you may withdraw your consent, in writing to the Club Secretary, at any time should you wish to do so.

Tick box to agree to Photography & Video Consent *

Name of Person Submitting Form

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Canvey Island Swimming Club