Club Organiser | Form Display

Witham Dolphins Membership Application for Vounteering. Thank you for volunteering - any queries please email us at info@witham-dolphins.org.uk. Please use the additional information section below to let us know what you are volunteering for, and also your swimmers name if applicable. Please also it to provide any relevant details to help us provide you with a positive experience. Some examples may include: gender pronouns, reasonable adjustments you require, or simply a preferred nickname. If you are already a member of Swim England please provide your membership number and current club details.

Additional Information

First Name

Last Name

Date of Birth

Ethnicity

Address Line 1

Address Line 2

Town

County

Postcode

Email Address (Main)

Home Phone No.

Mobile Phone No.

Emergency Contact 1 - Name

Emergency Contact 1 - Mobile No.

Emergency Contact 1 - Relationship

Emergency Contact 2 - Name

Emergency Contact 2 - Mobile No.

G.P. Name

G.P. Telephone No.

Emergency Contact 2 - Relationship

Specific Medical Details

Medication Details

I confirm that I have read, and agree to abide by the code of conduct and the club policies.
I acknowledge receipt of the rules of the club and confirm my understanding and acceptance that such rules (as amended from time to time) shall govern my membership of the Club.
I further acknowledge and accept the responsibilities of membership upon members as set out in these rules.

Tick box to agree to Code of Conduct & Club Policy *

The Codes of Conduct and Privacy Policy can be found on our website at - https://www.witham-dolphins.org.uk under Club Policies. All data collected on this membership form will be kept securely by club personnel and medical/disability information will be provided to teachers/coaches on a need-to-know basis.