Horsham Lifesaving Club - Get Involved

Title :

Mr Miss Mrs Ms

Surname:

Forenames:

House Name/Number:

Street :

Town:

County :

Post Code: (example RH12 3AB)

Telephone number: (example 01403 112233)

Email: (example jo.blogs@hotmail.com)

Date of Birth (DD/MM/YYYY):

Gender:

Male Female

Details of any previous lifesaving/first aid/swimming qualifications:

I am not suffering from any medical condition of which the teachers should be aware.

If you have such a problem e.g. asthma, please give details below:

Data protection Act 1998

In accordance with the Data Protection Act 1998 this information will not be used other than for the purposes of Horsham Lifesaving Club.

Child Protection Statement

Horsham Lifesaving Club is required by ‘Lifesavers’ (The Royal Life Saving Society) to include the following statement in this document:

“It is the policy of Lifesavers to safeguard the welfare of children and all others involved in it’s activities by protecting them from physical, sexual and emotional harm”

All parents of child members will be asked to sign a Parental Consent Form and all adults (over 18 years) will be required to complete a CBR (Criminal Records Bureau) Disclosure Form and for this to be submitted in the normal way via the RLSS HQ.

Please tick here to confirm that you have read and understood the above and that you understand that the course involves swimming at the maximum depth of the pool and also involves assisted lifting and the use of equipment such as ropes, poles and floatation aids.

I accept the risks involved in this activity .I also acknowledge that the nature of the activity involves physical contact with other participants.