2020 Poolside Pass Registration Form

1

Name* This field is required.

First Name

Last Name

2

Swim England Membership NumberThis used to be called your ASA membership number

3

Club Name* This field is required.

4

Swim England Club Code* This field is required.This is a 4 letter alphabetic code

5

Is your Club Swim Mark accredited?

Yes

No

7

DBS Number* This field is required.

8

DBS Check Date:* This field is required.

9

E-mail Address of Applicant* This field is required.

10

Phone Number of Emergency Contact* This field is required.Landline or mobile

First 5 digits

Last 6 digits

11

How do you want to upload your photo?* This field is required.

Use the camera on my mobile or laptop device.

Use a photo I already have on my device

12

Take your Photo using your WebCam or Mobile Device* This field is required.If you do not have this facility available, click next and upload a pre-taken image on the next page.

13

Upload an existing image for Pass* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Portrait jpg, jpeg, png, gif files please

14

Please confirm the statement below* This field is required.

I have read, understood, and will abide by the Promoter's Conditions for the competition I am attending

15

Please confirm the statement below* This field is required.

I have read, understood, and accepted the DATA PROTECTION POLICY set out in the Promoter's Conditions for the meet I am attending

16

Once you submit your application, we will confirm acceptance and make a poolside pass available for you at the Gala Administraion desk.

Thank you!