ESC Swim England Registration Form

Please complete this form and answer all the questions.

Membership Category

Swim England Category 1 membership is for members of any age who are learning to swim or who are swimmers at any level, who do not compete in any discipline in open competition.

Swim England Category 2 membership is for members of any age who compete in any discipline in open competitions.

Swim England Category 3 membership is for all members of any age who are not in categories one or two namely administrators; associate members; coaches; helpers; honorary members; life members; officers; qualified officials of any discipline; patrons; teachers; temporary members; vice-presidents and verifiers or tutors of the Association’s educational certificates.

*

Category 1

Category 2

Category 3

Has the swimmer ever been registered with Swim England? *

Yes

No

Member ID (If Known)

Date of Birth * +

Title *

Forename *

Middle Initials

Surname *

Known As *

Select ESC House/Section *

Choose one *

Address *

Address Line 2

City *

Post Code *

Phone / Mobile Number *

parent Email Address if swimmer under 18 *

Gender *

Male

Female

Country Of Representation *

England

Scotland

Wales

Other(please specify) Other(please specify)

Swimming Discipline *

Are you a member of another Club? (If yes, please state Club Name) *

No

Yes Yes

If a member of another club, is Ealing your rank Club? *

Yes

No

I confirm that I am a member of the club(s) listed above. I agree to abide by the rule of Swim England and British Swimming. If I am submitting this form as Catergory 2, I confirm that I am a competitive member of the club listed above. I confirm that I will submit myself to official Doping Control at any time when requested. I understand that by submitting this form, I am consenting to receive information about Swim England/British Swimming initiatives from the Swim England/British Swimming and their commercial partners by post, email, SMS/MMS, online or phone unless I tell you otherwise.

Hide my details
Caution: If you hide your details they will not be visible on the Ranking Database which may affect your ability to enter events. Event organisers may in these cases require proof of age and or of eligibility to enter a meet.

If you do not want details of your achievements to be visable on the British Swimming Website, please tick here.

Signature of Club member ( Please type) *

Date * +

Signature *

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The section below MUST be signed by the parent / guardian of any member under the age of 18 years. As the parent or person in loco-parentis of the swimmer named above. I also agree to release his/her personal and other details for the purpose of maintaining records.

Signed *

Date * +

Signature

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