Update Details

MEMBER INFORMATION AND MEDICAL UPDATE

We are required to update all members personal and medical information.

Please complete the form below to update your details. We ask that all members of the club, swimming and non-swimming complete the form. If you would prefer to complete a paper copy copies are available at the sessions.

Update Details

Full Name:*
Date of Birth:*
Email :*
Address & Postcode:*
Contact Number:*
Emergency Contact Name:*
Emergency Contact Number:*
Membership:
- Junior Swimmer
- Adult Swimmer
- Non-Swimming Member

Do you have any medical conditions or learning difficulties? If yes please provide details below:
Do you have any food, drug or other allergies? If yes please provide details below:
Do you take any regular medication or medication for asthma? If yes please provide details below:
Are there any other considerations we should be aware of? If yes please provide details below:
Do you have any special dietary requirements? If yes please provide details below:

1. To the best of my knowledge and belief, the information given above is complete and accurate. I will inform the club of any changes.:
- I confirm
2.In the event of an emergency I give my permission for teachers, coaches or team management to obtain urgent medical treatment which may be required:
- I confirm
3. I am aware of the type of activities likely to be undertaken and consent to myself/my child taking part :
- I confirm
4. I acknowledge that the club will be liable in the event of an accident only if they have failed to take reasonable steps in their duty of care:
- I confirm
4. I understand that, in compliance with the Data Protection Act 1998, all efforts will be made to ensure that this information is accurate:
- I confirm
Name of person completing form if member is under 16 years old:
Relationship to member:

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