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LHSS Annual Membership 2021 Includes Swim England Registration, County Affiliation and Insurance.
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* Indicates required question
Member's Full Name
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Your answer
Date of Birth
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Your answer
First Line of Address
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Your answer
Post Code
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Your answer
Home Phone Number (inc dialling code)
Your answer
Parent/Guardian Name
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Your answer
Parent/Guardian Mobile Number
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Your answer
Parent/Guardian Email
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Your answer
Additional Parent/Guardian Name (optional)
Your answer
Additional Parent/Guardian Mobile Number (optional)
Your answer
Additional Parent/Guardian Email (optional)
Your answer
School Member Attends
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Your answer
Please tick all that apply to Member
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Takes regular medication?
Requires medication during training session?
Has Eyesight problems?
Has Hearing problems?
Has Allergies?
Has Learning or Behavioural issues?
Has other relevant problems or conditions?
None of the above.
Required
If you have ticked any of the questions above please give full details here.
Your answer
[You must tick all boxes] I / we understand that by signing this form I / we:
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Agree to follow the "LHSS Code of Conduct"
Confirm understanding of "LHSS Club Constitution"
Will ensure all fees are paid on due date
Wish to "opt in" to receive group email
Required
I give Consent for Member to be photographed for LHSS publicity:
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Yes
No
Required
[Please tick] I agree to make payment of £50 using the following method by Mon 15 Feb:
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Bank Transfer to Bank: HSBC, Account Name: Locks Heath Swim Squad, Account Number: 41395181, Sort Code: 40-21-03, Ref "name"MS2021
Required
Parent/Guardian print name below as Signature
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Your answer
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