Killarney Swimming Club
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1 Killarney Swimming Club MEMBERSHIP CONSENT FORM To be completed by parents/guardians of all swimmers under 18 and by all swimmers 18 & over Athletes Name : Date of Birth: Address: Parent s work phone number: Parent s mobile phone number : Medical Consent Please tell us about any medical conditions and treatment to be followed in an emergency to include: Are there any specific conditions requiring medical treatment or medication including dosage and frequency; Are there any dietary or nutritional supplements being taken, including dosage and frequency; Are there any restrictions on the type of pain relief that may be given to your child if considered necessary? Does your child suffer from asthma, and if so, is s/he registered with Swim Ireland as asthmatic? Does your child take any medication for asthma? Does your child have an up to date tetanus vaccination? Does your child have any food, drug or other allergies? Does your child suffer from any disabilities (physical, visual, hearing or learning) or recognised behavioural problems that could affect their behaviour when training or in competition? Does your child have any specific dietary needs? Has your child been in contact with any contagious or infectious disease or suffered from anything in the last month that may be infectious? Is there any other information that the Club committee/coaches need to be aware of? If the answer is Yes to any of the above, other than in relation to tetanus, please give more information below: Doctor s name Phone number I am aware of the nature of the activity to be undertaken by my child as a member of Killarney Swimming Club and give consent for my child to take part in all the activities involved. I understand that my child may be required to undergo physical & physiological testing of attributes such as height, weight, flexibility, strength & may be asked to perform various activities, both in and out of the water, on equipment associated with their particular discipline. Some performance tests will require my child to give maximum effort. I have not been informed by any medical practitioner that participation by my child in such activities would be dangerous. I give permission to relevant medical personnel or designated person, on my behalf, to administer any medication/treatment deemed necessary in an emergency situation where it would be contrary to my child s interest for any delay to be incurred in seeking my personal consent. I understand that it is my full responsibility to keep the club updated with all relevant information, especially medical conditions and emergency contact details. Parent/guardians signature: Parent/Guardian s Name: (print) Dated: [1]
2 Media Consent Killarney Swimming Club requests permission to use individual and group photographs and/or to record video footage for training, competition and/or promotional purposes. This permission is sought on the basis that the Swim Ireland Photography and Filming Policy and Procedures as specified in Swim Ireland Safeguarding Children Policies and Procedures 2010 (or any updates issued) will be followed. Attendance at a Swim event/activity may result in participants being photographed or filmed as part of the occasion, either as an individual or as a member of a group. Participants must also accept that they may also appear in a photograph or video inadvertently. I confirm that I give permission for my child to be filmed and/or photographed during or as part of Killarney Swimming Club events and/or training sessions, and these photographs/videos may be used in Club media coverage, on the club notice board or as part of the club gallery on the club website. I understand that this permission will remain valid for the period of membership of the Killarney Swimming Club unless brought to the attention of the Committee. Photographs/videos will only be taken for Killarney Swimming Club by an appropriate person appointed to do so by Killarney Swimming Club. Events/training includes all training sessions, camps, competitions or any other activity organised by Killarney Swimming Club members. Parent/guardians signature: Parent/Guardian s Name: (print) Dated: DATA PROTECTION Killarney Swimming Club is committed to ensuring the data protection rights of you and your child. The information that you submit on this form is collected and processed in accordance with the Data Protection Acts and our privacy policy available at Please ensure you read and understand this privacy policy before submitting this form. Any sensitive personal data contained on this form will only be made available to those persons that strictly require access to it, namely internal Killarney Swimming Club or Swim Ireland personnel and members of the Irish Institute of Sport who accompany or assist you on our activities. The confidentiality of the information will be respected at all times. General Consents I understand that Killarney Swimming Club will use information collected only in connection with the purpose and activities of the club. I also note that the club supplies information to Swim Ireland and to gala organisers and results of competitions are published including ages. I am aware that the information declared may be retained by Killarney Swimming Club in paper form and stored on computer. Copies will only be made available to those persons who will be responsible for supervising my child but confidentiality of the information will be respected at all times. Data may be stored in accordance with the club s Privacy Policy and Terms of Use which can be found on the club s website at and I accept the terms of same. I have read, understood and agree to abide by (a) the Swim Ireland Codes of Conduct and Policies, (b) the Swim Ireland Safeguarding Children Policies and Procedures 2010, (c) the Rules of Swim Ireland, (d) the Constitution of Killarney Swimming Club, the Club Rulebook and its Code of Conduct, (e) the Swimmer Contract and (f) the Parent on Duty rules (all of which are available on request or either on the club website at or the Swim Ireland website at ) and acknowledge that both my child and I must abide by the conditions and terms of these documents at all times. I understand that failure to do so may result in sanctions being applied. In the event that such action involves expense, I accept responsibility to meet any such expenses incurred. Parent/guardians signature: Parent/Guardian s Name: (print) Dated: To receive the Club blog on Club news and events, please provide an address here: [2]
3 Swimmer Contract I agree to abide by the Constitution and Rules of Killarney Swimming Club (both documents available at ) and the Rules of Swim Ireland and I particularly note and accept to the following: 1. Swimmers will respect and show courtesy to their teammates and coaches at all times. 2. Swimmers must get in the water on time for practice and competition warm-ups. Any swimmer more than 10 minutes late for the session OR if the warm-up has finished will not be allowed enter the pool for that training session, for health and safety reasons. 3. All swimmers will be respectful of their teammate s feelings and personal space. Swimmers who exhibit sexist, racist or inappropriate behaviour towards another person will be excused from the practice or competition and will be subject to a disciplinary process as determined by the head coach and/or club committee depending on the severity of the infraction. Any coach at any time has authority to ask a swimmer to exit the pool for disciplinary reasons. 4. No dunking, foul language, hanging on lane ropes, splashing, spitting, hitting, or any other behaviour deemed as horseplay is allowed in a practice venue or competition venue. 5. Killarney Swimming Club is a competitive swimming club and ALL swimmers will be expected to compete in at least 2 competitions each swimming season i.e. September to July inclusive. 6. Swimmers are expected to exhibit good sportsmanship at practice and competitions. 7. Neither swimmers nor parents shall ever confront an official or stroke and turn judge at a competition about a disqualification. This is the coach s responsibility. Swimmers and parents will be respectful and courteous to meet volunteers at all times. If you have a problem, come get your coach. 8. Swimmers who have contagious illnesses or open wounds must tell their coach before entering the water. 9. A swimmer who is injured at practice or a competition must report this to their coach immediately following such injury. 10. Swimmers are responsible for checking in with the coach for heat and lane assignments, reporting to their coach and for being behind their block prior to their race. 11. Swimmers must attend a minimum of 75% of sessions in each term as otherwise eligibility issues may arise under the Club Rules. I understand that Swim Ireland is an organisation of trained volunteers and paid professional officials. I further understand that Killarney Swimming Club and all competitions are operated by volunteers. I agree to treat volunteers and competition officials with respect. Signed: (Swimmer) Signed: (Parent) Date: [3]
4 wwwww.killarneyswimmingclub.com Swim Ireland Membership Form Swim Ireland Number if existing member Club ID: Club Name: Killarney Swimming Club Title: Gender First Name: Address 1 Middle Name: Address 2 Surname: Address 3: Date of Birth: Town: Family Head ID: County: Phone: Country: Mobile: Please Tick here if this person is a head of family If not can you enter the ID of the head of their family (U21) Roles: Chairperson Head Coach Disciplines: Competitor Non- Competitor Swimming Secretary Coach Water Polo Treasurer Teacher Diving Designated Person Team Manager Masters Children s Officer Official Open Water Committee Synchronised Swimming [4]
5 Member Yes No Do you agree to abide by the Safeguarding Children Policies and Procedures and rules of Swim Ireland and Club? Do you agree to abide by the code of conduct as laid out by Swim Ireland and Club? Have you ever been asked to leave a sporting organisation? (If you have answered yes, we will contact you in confidence) Have you ever been convicted of a criminal offence or been the subject of a caution; a Bound Over Order; or are you at present the subject of criminal investigations? Applicant's Signature: Date: (If the Application is for an under 18 then the parent must also sign) Parent's Signature: By signing this form you give your club secretary permission to enter your details onto the Swim Ireland online database. Please remember that the information you are sending to Swim Ireland Head Office through this form is personal data and must be treated in accordance with the Data Protection Acts, 1988 and Please read your club s data protection policy for further information. Declaration of Club Secretary: As the Club Secretary I confirm that the above named has been accepted and is involved as a member of the club, and I have verified their date of birth. Club Secretary: Signature: Name: For all NEW members this form must be printed, signed and the hard copy kept by the club for official records. *Please note evidence that the club are holding these forms in a safe and secure location will form part of the Club Mark process. It is your responsibility as club secretary for ensuring the accuracy and validity of the information that you submit using this form and Swim Ireland accept no responsibility whatsoever for any errors or omissions that you may make. [5]
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