Club Organiser | Form Display

Witham Dolphins Masters Membership Application. Please complete all details below, we will be in touch to discuss when a trial date becomes available. Any queries please email us at info@witham-dolphins.org.uk. Please use the additional information section below to provide any relevant details to help us provide you with a positive experience. Some examples may include: gender pronouns, reasonable adjustments you require, previous swimming experience or simply a preferred nickname. If you are already a member of Swim England please provide your membership number and current club details.

Additional Information

Swimmer's First Name

Swimmer's Last Name

Swimmer's Date of Birth

Swimmer's Birth Sex

Ethnicity

Address Line 1

Address Line 2

Town

County

Postcode

Email Address (Main)

Home Phone No.

Mobile Phone No.

Emergency Contact 1 - Name

Emergency Contact 1 - Mobile No.

Emergency Contact 1 - Relationship

Emergency Contact 2 - Name

Emergency Contact 2 - Mobile No.

Emergency Contact 2 - Relationship

G.P. Name

G.P. Telephone No.

Medical Information

Medication Details

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 *

Photos to be used on club (secure) website

Tick box to agree to Photo & Video Consent - Website

Photos to be used on club social media platform/s

Tick box to agree to Photo & Video Consent - Social Media

I confirm that I have read, and agree to abide by the code of conduct and the club policies.
I acknowledge receipt of the rules of the club and confirm my understanding and acceptance that such rules (as amended from time to time) shall govern my membership of the Club.
I further acknowledge and accept the responsibilities of membership upon members as set out in these rules.

Tick box to agree to Code of Conduct & Club Policy *

The Codes of Conduct and Privacy Policy can be found on our website at - https://www.witham-dolphins.org.uk under Club Policies. All data collected on this membership form will be kept securely by club personnel and medical/disability information will be provided to teachers/coaches on a need-to-know basis. If after our trial you do not proceed and become a member of Witham Dolphins all data held will be deleted.