New Member Registration for Holywell Amateur Swimming Club

Welcome. Please enter all member details below.

Member Details

First Name

Known As

Last Name

Date of Birth

Gender

Home Phone

Mobile Phone

Address 1

Address 2

Address 3

Town

County

Postcode

Primary Contact Name

Relationship To Member

Ethnicity

Emergency Contact Person 1

Emergency Contact Phone 1

Emergency Contact Person 2

Emergency Contact Phone 2

School Attended

Consents

Consent To Travel

Consent Image Use

Consent Video Use

Loco Parentis Rights

I Consent You Can Store My Information

As part of the GDPR (General Data Protection Regulation), you must consent to us storing your information

To effectively run our club we will need to contact you for example when sending out gala eligibility emails and other communications relating to the club. In entering your details here, you are automatically acknowledging this.

Medical Details

Medical History

Allergies

Disability Details

Doctor

Doctor Address

Doctor Phone

Parent Details

IF the details you entered above are a child's details AND you are their parent/guardian, please click the check box below and enter your details if you have not already entered your own details on a previous form:

I Am The Parent/Guardian

Enter your details below and a parent acount will be automatically created for you and linked to your child's account:

Your First Name

Your Last Name

Your Email Address

Your Home Phone

Your Mobile Phone

Security Check