REGISTRATION FORM
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MEMBERSHIP DECLARATION
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MEMBERSHIP DECLARATION
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MEMBERSHIP TYPE:
New Membership For:
New Membership
Transfer of Membership
If Transferring Membership Please Provide Current Details:
SWIMMER DETAILS
Swimmer's First Name:
Swimmer's Last Name:
Swimmer's Street Address:
Swimmer's Suburb:
Post Code:
Swimmer's Phone:
Swimmer's Email Address:
Swimmer's Date of Birth:
Swimmer's Ethnicity
PARENT CONTACTS
Parental Contact Name 1:
Parent 1 Phone:
Parent 1 Email:
Parental Contact Name 2:
Parent 2 Phone:
Parent 2 Email:
Address ( if different from above):
SQUAD DETAILS
Please select Squad Level:
Cubs
Nippers
Juniors Level 3
Juniors Level 2
NAGs Transition
NAGs
Fitness 1
Fitness 2
Fitness 3
Fitness 4
Will the swimmer be competing in meets?
Yes
No
MEMBER DECLARATION
I HAVE READ AND I MAKE THE DECLARATION ACCORDING TO THE MEMBERSHIP DECLARATION (CLICK ON LINK AT TOP) AND AGREE TO BE BOUND BY CLAUSES 1-6.
Swimmer's Declaration of acceptance ( I accept )
Swimmer's Name:
UNDER 18 YEARS, PARENT, GUARDIAN, CAREGIVER CONSENT
I HEREBY DECLARE THAT I AM THE PARENT /GUARDIAN/CAREGIVER OF THE APPLICANT WHO IS UNDER 18 YEARS OF AGE. I HAVE READ AND UNDERSTOOD THIS APPLICATION FORM AND THE APPLICANTS MEMBERSHIP DECLARATION ( CLICK ON LINK AT TOP ) AND GIVE MY CONSENT TO THE APPLICANT'S MEMBERSHIP OF PSC,ASA,SNZ.
Caregiver's Declaration of acceptance ( I accept )
Caregiver's Name:
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