Member information and emergency contact details form - Deben ...

Deben Swimming Clubwww.debenswimmingclub.co.ukChairman: Carol NauntonSecretary: Karen WhightAffiliated to ASA East Region & Suffolk County ASA_____________________________________________________________________________________Deben Swimming Club Membership Information and Emergency FormTHIS FORM MUST BE COMPLETED FULLY IN BLACK INK AND CAPITAL LETTERS SO THAT WE HAVE CLEARCONTACT INFORMATION FOR EACH SWIMMER. E-MAIL ADDRESSES WILL BE USED TO SEND INFORMATIONTO YOU AS NECESSARY.Forename(s)_______________________________Surname _______________________________Date of Birth ______________________________ Male/Female ____________________________Address _________________________________________________________________________________________________________________________________________________________Telephone Number __________________________ Mobile Number __________________________(include full STD code)Medical Conditions (please give details) ___________________________________________________Disability Conditions (please give details) __________________________________________________Name of Parent/Guardian ______________________ Email address __________________________Additional Emergency Contact (other than parent/guardian) Name_______________________________Telephone Number __________________________ Mobile Number ___________________________(include full STD code)By becoming a member of Deben Swimming Club, you consent to the following:-I consent to the Club holding membership records on computer.I consent to photographs and videos of my son/daughter being used by the Club for publicity purposes.I consent to my son/daughter being filmed using the Club underwater camera for training purposes.I consent to abide by the Clubs Codes of Conduct and have read them in full www.debenswimmingclub.co.ukAll information will be held in strict confidence. Any changes to the above information must be submitted ona new form and either handed to a member of the coaching team or committee in a sealed envelope with theswimmers name. Alternatively a form can be downloaded from www.debenswimmingclub.co.uk and emailed to :debensc.membership@hotmail.co.ukPlease sign below to confirm that all the information above is correct and that you have read the DataProtection – Membership Data Collection – Consent statement overleaf.Swimming member - Name in capitals _______________________ Signature ______________________Signature of Parent/Guardian if under 18 years of age - Name in capitals __________________________Signature ____________________________ Relationship to swimming member __________________

Deben Swimming Clubwww.debenswimmingclub.co.ukChairman: Carol NauntonSecretary: Karen WhightAffiliated to ASA East Region & Suffolk County ASA_____________________________________________________________________________________British SwimmingData Protection - Membership Data Collection – ConsentThe Data Protection Act 1998 ("the Act") sets out certain requirements for the protection of your personalinformation (i.e. information about you) against unauthorised use or disclosure. The Act also gives youcertain rights.References below the British Swimming include a reference to the three members of British Swimming,the Amateur Swimming Association (ASA), Scottish Swimming Association (SASA) and WelshSwimming Association (WASA). By virtue of your membership direct or indirect to ASA, SASA andWASA you agree to your personal data being made available to British Swimming and its members,subject always to compliance with the Data Protection legislation. This does not include sensitivepersonal data such as health or medical conditions, which require the explicit consent of the data subjecti.e. a signature for this specific purpose.Except to the extent that your club or British Swimming is required or permitted by law, (the informationyou provide in this'form, and any other information obtained or provided during the course of yourmembership ("the information") will be used solely for the purposes of processing your applicationand dealing with you as a member.If you cease to be a member of the British Swimming, the information will not be held for longer than isnecessary, after which time it will be destroyed.You agree to use all reasonable endeavours to keep your club and British Swimming informed of anychanges to your personal data.So that we may use the information for the above purpose and on the above terms, we are requiredunder the Act to obtain your consent. Members are therefore requested to sign the consent clause onthe reverse of the membership forms or by confirming to their Club Membership Officer that they agreeto the above by providing their data for electronic submission to the ASA, SASA or WASA