Membership Form

Please complete all required fields!

Age of Member*

Please select an option

Member's Details

Name*

Please let us know your name.

Contact Number*

Please let us know your contact number

SLSGB Membership Number*

Please let us know your membership number

Address*

Please let us know your address

Postcode*

Please let us know your postcode

Date of Birth*

Please let us know your date of birth

Swimming Capability*

I confirm that this member can swim 50 Meters in a swimming pool

Please confirm

Adult Member Details

Member's Name*

Please let us know your name

Adult SLSGB Membership Number*

Please let us know your membership number

Adult SLSGB Membership Card Photo*

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Member's Address*

Please let us know your address

Member's Postcode*

Please let us know your postcode

Mobile Telephone Number*

Please let us know your mobile telephone number

Date of Birth*

Please let us know your date of birth

Swimming Capability*

I confirm that this member can swim 50 Meters in a swimming pool

Please confirm

Next Of Kin Contact Details

Name*

Please let us know their name

Address*

Please let us know their address

Mobile Telephone Number*

Please let us know their mobile telephone number

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Child Health & Safety Form

Doctor's Details

Doctor's Name*

Please let us know your child's doctor's name

Doctor's Address*

Please let us know your child's doctor's address

Doctor's Surgery Postcode*

Please let us know your child's surgery postcode

Doctor's Telephone Number*

Please let us know your child's doctor's number

Parent / Guardian Details

Name*

Please let us know the parent/guardian's name

Mobile Telephone Number*

Please let us know the parent/guardian's mobile phone number

Email*

Please let us know their email

Secondary Parent / Guardian Details

These fields are optional, but if there is someone else who we should hold details for then please enter them below.

Name

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Mobile Telephone Number

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Medical Details

Does your child suffer from any of the following illnesses or disabilities which may require medical treatment?

Asthma*

Yes