2022 Poolside Pass Registration Form

1

By completing this form, you are permitting Surrey County ASA to contact you on either the email or emergency mobile phone number you provide should we need to communicate regarding the 2022 Surrey Age Group Championship Meet. Your email and phone number will be deleted from this submission after the meet is completed in accordance with the Data Protection Policy set out in the Promoter's Conditions for the meet.

2

Name* This field is required.

First Name

Last Name

3

Club Name* This field is required.

4

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

5

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

6

What role will you have on Poolside?* This field is required.DO NOT use this form if you are applying as a Coach, Team Manager or Chaperone. Please use the link specifically designed for your category on the Surrey website.

Non-Technical Official

VIP/Guest

L2 Teacher

7

Swim England Membership Number* This field is required.This used to be called your ASA membership number

8

Does your club have an active SwimMark registration?* This field is required.

YESNO

9

Enter the date of your latest DBS certification* This field is required.

10

Enter the date of your latest Safeguarding certificate* This field is required.

11

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

12

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

First 5 digits

Last 6 digits

13

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

14

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.

15

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

16

Please confirm the statement below* This field is required.

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

17

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

18

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

Thank you!