Swans Tri Club Membership Form

Member Details:
Full Name *

First Name Last Name
Are you an Existing Member? *

Yes No
Swans Membership Number: *
Gender: *

Male Female Prefer Not to Say
Date Of Birth: *

Day Month Year
Date

Address *

Street Address
Street Address Line 2
City	County
Postal Code	Country

E-mail *

Phone Number *

Street Address
Street Address Line 2
Home	Mobile
Zip Code	Country

Emergency Contact *

Street Address
Street Address Line 2
Name	Phone Number
Zip Code	Country

Details of Parent / Carer (Under 18 Only)

Street Address
Street Address Line 2
Name	Phone Number
Zip Code	Country

Are there any activities that you/your young child/young person cannot participate in?
Emergency Contact Details:
Name of Alternative Adult to be contacted in emergency: *

First Name Last Name

Phone Number *

Street Address
Street Address Line 2
Home	Mobile
Zip Code	Country

Relationship to member: *
Medical Information:
Do You/Your child/Your young person take any existing medications?
Do You/Your child/Your young person have any allergies?
Do You/Your child/Your young person ever had any operations?
Do You/Your child/Your young person have any general health problems?
Do You/Your child/Your young person have any of the following medical issues?

High/Low Blood Pressure Asthma Hearth Disease Epilepsy Abnormal Heart Rhythms Physical Disabilities (include Visual & Hearing) Stroke Joint or muscle problems Learning Disabilites
If answered yes to ANY of he above OR have any other medical problems please Specify:
Sporting Activities:
Are you currently active in Sport? If so what? How Often?
Have you ever been active in Sport? If so what? When was this? At What Level?
Membership Agreement:
Membership Type

Individual - £25.00 Junior - £15.00 Family of upto 4 (Max 2 Adults) - £65.00 Family of upto 6 (Max 2 Adults) - £90.00 Concessions - £20.00
British Triathlon Membership Number (if applicable)
Membership Payment Details:
Payment Method

Full Payment Cash Full Payment Bank Transfer
Account Details : Sort Code 09-01-29 Account : 31492775

Please use Ref: MEMBERSHIP
Consent/privacy (GDPR)/disclaimers
We take your privacy seriously and will only use information gathered in relation to our team that meets the specific responsibilities as set out in General Data Protection Regultions. However, from time to time we would like to contact you with details of fixtures, events, competitions and other information regarding the team. If you consent to us contacting you for these purposes please tick to say how you would like us to contact you
How can we contact you?

Phone E-mail Text
Swans Tri Club will store your information on our team’s data base for a maximum of 18 months unless re-registering. Note: if you use our Team App or follow our Facebook page you should turn off notifications/IM groups if you don't want to recieve these.
The Member warrants and represents upon their Membership Application Form, and repeats such warranty upon each visit to team activities, that they are in good physical condition and know of no medical or other reason why they should not engage in any form of exercise, and that such exercise would not be detrimental to their health, safety, comfort or physical condition. While we will make every effort to accommodate everyone no matter of fitness level, health problems or disabilities it is your responsibility to make sure you/your child are fit to participate in any session, that you/your child tell the coach before the session if any new problems have arisen and that you/your child stop exercising immediately if experiencing pain dizziness or breathing difficulties.
Member Signature: *

Clear
Parent/Guardian Signature: If Under 18

Clear
Date Of Application

Month Day Year
Should be Empty:

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Member Details:

Emergency Contact Details:

Medical Information:

Sporting Activities:

Membership Agreement:

Membership Payment Details: