ASC Membership Form

DECLARATION

If accepted as a member I agree:

□ To promote the best interests of the Club, the swimmers and other members at all times;

□ To follow the rules as defined in the Club Handbook and abide by the Code of Conduct;

□ To pay the annual registration fee at the time of registration and take full responsibility for costs incurred on my behalf;

□ To pay the pool entry fee and to pay set monthly Squad Fee regardless of attendance;

□ 30 days notice to be given in writing if withdrawing from membership;

□ That all swimmers and one adult family member will attend Race Nights;

□ To contribute to fundraising by either: at least 6 hours of fundraising volunteering OR agree to pay a fundraising levy of $150 per swimmer.

□ That Australind Swimming Club will not be liable for any expenses related to or indirectly incurred by any medical condition before, during or after any club activity.

□ To give Australind Swimming Club the right and permission with respect to photographs and videos that may be taken of you by the Club to be made available to the Club for the sole purpose of Club promotion. This includes but not limited to publication in newspaper, swimming programmes, Club brochures, website and Facebook page. I release ASC from liability for any violation of any personal or proprietary right I may have in connection with such use. (Please note material taken for Coaching purposes are exempt from this guideline).

□ Registration valid Oct – Sep each year

Type of Membership *

Renewal
New Member
Transfer

Please enter your swimmers full name *

First

Last

Swimmers date of birth (please input date dd/mm/yyyy) *

Home Address *

Gender *

Male
Female
Non-binary
Prefer not to say

Emergency contact full name *

Emergency contact phone number *

Emergency contact relationship to swimmer *

Email *

Declaration accepted

Informed Consent and Acknowledgement *

I, as the Swimmer or Parent/Guardian, (in respect to an applicant under the age of 18 years): 1. understand that Swimming WA and the Australind Swimming Club will be responsible for handling personal information. This is for emergency contacts and medical information and personal information will not be passed on to any other third party (other than the coaches) without the applicant’s consent. 2. assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Australind Swimming Club and all its respective officers, agents, and representatives from all liability for injuries to said child participating in or conducted during the sessions. 3. consent for my child to be administered such emergency medical treatment as is reasonable/necessary and that I will reimburse any necessary expenses incurred. 4. hereby waive all claims against Australind Swimming Club including all coaches and affiliates, all participants, and, if applicable, owners and lessors of premises used to conduct the event. I have read, understood, and agree to the above declarations.

Consent and Acknowledged by: *