Membership Form

Swimmers Details

First Name

Last Name

Address

Emergency Contact Number 1

Emergency Contact Number 2

Date of Birth required

Gender

Medical Details

Doctors Name & Surgery Address

Please give details of any medical condition

Please state any medication received on regular basis

Any known allergies

Please give details of any learning difficulties (e.g. deafness, needs to wear glasses etc.)

Parental Permission for Medical Treatment in an Emergency

In the unlikely event of an accident or illness which needs immediate treatment, I understand that representatives of Devizes ASC will try to contact me in the first instance. However should I be unavailable or unable to be present, I give permission for my swimmer to receive first aid and medical treatment as required from a qualified practitioner in the event of my absence. Required

I give my permission for my swimmer to receive medical treamtent in the event of an emergency

Photography Permission

Photographs may be taken of your swimmer whilst taking part in galas, at the club championship presentation or training. Devizes ASC only uses these photographs for the purpose of promoting the activities of the Club on the Club’s website or on social media. In compliance with Child Protection and the Data Protection Act, Devizes ASC will not use the photographs for any other purpose. Required

I give my permission for photographs to be taken of my swimmer and being used for publicity purposes on social media and the club website.

Your Details

Your name

Relationship to Swimmer

Mobile Number

Retype Email

Club By Laws & Code of Conduct

Please check the boxes below Required

I have read and agree to abide by the Club By Laws and Code of Conduct

I understand that no mobile phones or digital devices are to be taken into changing rooms or poolside. Any swimmer violating this instruction will be removed from the competition with immediate effect.

Should my swimmer wish to leave the club I will give a minimum of 2 months notice.

Devizes ASC By Laws & Code of Conduct can be found here.

Your Signature

130th Anniversary

1896 - 2026

Membership Form