Limerick Swimming Club Member Registration Form

1
Name* This field is required.
First Name
Last Name
2
Swimmers Date of Birth* This field is required.
Date
Day
Month
Year
3
Address
Street Address
Street Address Line 2
City
Please Select
Tipperary
Limerick
Clare
Antrim
Armagh
Carlow
Cavan
Cork
Derry
Donegal
Down
Dublin
Fermanagh
Galway
Kerry
Kildare
Kilkenny
Laois
Leitrim
Longford
Louth
Mayo
Meath
Monaghan
Offaly
Roscommon
Sligo
Tyrone
Waterford
Westmeath
Wexford
Wicklow
County
Eircode
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Parent or Guardian Phone Number:* This field is required.If U18, This is the phone number of the swimmers Parent or Guardian
Area Code
Phone Number
5
Parent or Guardian Email Address* This field is required.If U18, This is the email address of the swimmers Parent or Guardian
example@example.com
6
Medical Details* This field is required.Please do not leave blank - If there is no information please write 'None'
Huge
Large
Normal
Small
Ok
Ok
7
Emergency Contact Details* This field is required.Please indicate the information to indicate the person who should be contacted in the event of an incident/accident.
Emergency Contact 1 Name
Emergency Contact 1 Relationship
Emergency Contact 1 Contact Phone Number
Emergency Contact 2 Name
Emergency Contact 2 Relationship
Emergency Contact 2 Phone Number
8
In accordance with the Swim Ireland Filming and Photography policy,

1. We only permit photographs, video or other images of children/young people to be taken with consent. Photographs/videos will be taken by an appropriate person appointed to do so by Limerick Swimming Club.

2. Any images will be used, held and stored in accordance with the Swim Ireland Filming and Photography Policy as specified in latest version of the Swim Ireland Safeguarding Polices.

3. No child/young person will be identified individually in any published image or film footage. Limerick Swimming Club request permission to photograph and/or record video footage of your child’s involvement in their sport for the purposes of training, publicising and promoting the club and/or sport.
9
Limerick Swimming Club take the protection of the data that we hold about you as a member seriously and will do everything possible to ensure that data is collected, stored, processed, maintained, cleansed and retained in accordance with current future data protection legislation. Please read the full privacy notice carefully to see how Limerick Swimming Club will treat personal information that you provide to us. We will take reasonable care to keep your information secure and to prevent unauthorised access. Limerick Swimming Club adhere to the Swim Ireland privacy statement. Please view the policy online at Swim Ireland Policies .
10
When you become a member of or renew your membership with Limerick Swimming Club you will automatically be registered with Swim Ireland through the Swim Ireland online membership database. We will provide Swim Ireland with your personal data which they will use to enable your personal access to the membership database. Swim Ireland will contact you to sign in and update your profile (which, amongst other things allows you to set and amend your opt-ins and privacy settings). It is vital therefore that a valid email address is given, so that you can ensure that your data is correct and so that your own privacy settings. If you have any questions about the continuing privacy of your personal data when it is shared with Swim Ireland, please view the privacy policy here Swim Ireland Privacy Policy or on sign up through the online membership database you will be presented with the relevant policy.
11
I agree to abide by the Swim Ireland Safeguarding Policies (latest update) and Rules of Swim Ireland and Limerick Swimming Club.* This field is required.
YESNO
12
I have never been asked to leave a sporting organisation. (If you Disagree with this statement, we will contact you in confidence)* This field is required.
AgreeDisagree
13
I consent to my special category personal data provided in Section Medical Details to be shared with coaches/team mangers or other appropriate personnel for the purposes of the delivery of safe participation in club activities.* This field is required.
YESNO
14
I confirm, I have read and understood Limerick Swimming Club Privacy ?Statement* This field is required.
YESNO
15
If I am a competitive swimmer, I agree to my personal data and swimming times to be held and processed though Hy-Tek’s swimming software.* This field is required.
YESNO
16
My mobile phone number will be included in the relevant squad ‘Whats App’ groups and for other club communications. * This field is required.Note: E-mail is the official form of communication.
YESNO
17
Swimmers Signature* This field is required.
18
Parent or Guardian Signature* This field is required.If member is under 18 the parent/guardian must also sign
Should be Empty: