KMSC Club membership form 2025

Club Membership Form

Welcome to KENILWORTH MASTERS SWIMMING CLUB! In order to ensure we can provide you with a safe and enjoyable experience please complete the details below and submit to the club's Membership Secretary (contact details at end of form for any queries) alongside your membership fee (for details visit https://kenilworthmasters.co.uk/join-us/).

If the new club member is under 18 years of age then please provide contact details for the parent/guardian as an emergency contact and state the relationship to the swimmer.
Name*
Date of Birth*

DayMonthYear
Date
Gender*

MaleFemalePrefer not to sayPrefer to self describe
Open / Female Category (For the purpose of competition)*

Male or OpenFemale
Category*

Competitive swimmerNon competitive swimmerSupport only (non-swimmer)
Country of representation (competitive members only)

EnglandScotlandWalesOther
Disciplines (indicate all that are relevant)*

SwimmingWater PoloSynchroDivingOpen WaterMasters SwimMasters Water PoloMasters SynchroMasters DivingMasters Open Water
Telephone*

Area CodePhone Number
Email Address *
example@example.com
Parent Email Address if under 18
example@example.com
Address*
Medical Information or N/A (Please include any primary and secondary impairments. All disclosures will be kept confidential).*
Medication (or N/A)*
Allergies (or N/A) *
Emergency Contact 1*

First NameLast Name
Emergency contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2*

First NameLast Name
Emergency Contact 2 Phone number*

Area CodePhone Number
Ethnicity i.e. White British, Mixed White & Asian, Black Caribbean etc
Additional Information Please include any information that you believe is relevant to help us provide you with a positive experience Some examples may include gender pronouns, reasonable adjustments you require or simply a preferred nickname.
Are you a member of another Club? If yes, please list below.
I confirm that I have read, and agree to abide by the code of conduct and the club policies. I acknowledge receipt of the rules of KENILWORTH MASTERS SWIMMING CLUB and confirm my understanding and acceptance that such rules (as amended from time to time) shall govern my membership of the Club. I further acknowledge and accept the responsibilities of membership upon members as set out in these rules.
Signature (of Parent/Guardian if under 18)*

Clear
Date*

DayMonthYear
Date
I have paid my membership fees. *
All data collected on this membership form will be kept securely by club personnel and medical/disability information will be provided to teachers/coaches on a need to know basis. If at any time any of the above details change, or you have any queries, please contact the membership secretary. membership@kenilworthmasters.co.uk
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