Club Membership Registration

Swimmer Details

Swimmer Name (required)     Sex (required)   FemaleMale

Age (required)   Date of Birth (required)

Email Address  

Address (required)

Contact Information

Name & Telephone No (Parent / Guardian) (required)

Name (required)     Telephone # (required)  

Email Address (required)     Note: For persons under 18 years this address will be used as the primary contact

Relationship:    Mother Father Guardian

Name & Telephone No (Parent / Guardian (optional)

Name     Telephone #  

Relationship:    Mother Father Guardian

Emergency Contacts

Name (required)  

Mobile Number (required)  

Relationship:    Mother Father Grand Parent Other Relation Child Minder

For Swimmers under 18 only

Please indicate if there is any relevant medical information that our coaching staff should be made aware of.
Yes No 
(If yes, we will endeavour to arrange a suitable time for you to meet with your child’s coach to discuss further)

Parental / Guardian Consent

I hereby consent to Asgard Swimming Club administering appropriate medical attention to the above named swimmer in the event of illness or injury whist participating in club activities.

I hereby consent to my child participating in the activities of Asgard Swimming Club

Name (required)