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					                      PERRANPORTH SURF LIFE SAVING CLUB
                             MEMBERSHIP FORM
                                    2009

Personal data collected on this form will only be used for the purpose of club
administration as required by the club and will not be disclosed to third parties.

I wish to apply for membership of Perranporth Surf Life Saving Club in one of the
following categories: (note: fee includes SLSA fee)


YOUTH          £40.00             16 - 19 years

JUNIOR         £35.00             13 - 15 years     All ages as of 1 st January

NIPPER         £30.00              7 - 12 years


NAME.......................………………………………………………………………. ……….
ADDRESS...........................…………………………………………………………………
…………………………………………………………………………………………………..
…………………………………………………………………………………………………..
TELEPHONE.....................................…MOBILE.………………………..................
EMAIL...........................…………………………………………………………………..
D.O.B.......................................
AGE....………..............OCCUPATION……………………….………………………….

AWARDS/QUALIFICATIONS HELD

...........................…………………………………………………………………………….…
…………………………………………………………………………………………

I agree to abide by the constitution and rules as laid down in the Perranporth Surf
Life Saving Club constitution.


Signed......................................................Date................…………………………
(Parent/Guardian for Nippers/Juniors)

Please make cheque payable to: PERRANPORTH S.L.S.C
and forward with completed and all signed forms to:-
Mrs Jeanne Barsch `
Barn Coombe', Penwartha Coombe, Perranporth, TR6 0AZ
email: jeanne@perranporthslsc.org.uk



                                                                        NIPPER/JUNIOR/YOUTH 2009
                                        Perranporth Surf Life Saving Club
                                          Emergency Contact and Data Form

Data Protection Act. The information being collected on this form will only be used for the
purpose of Club administration of visits and journeys under child protection guidelines. The data
will not be disclosed to any external sources other than in an emergency, without your written
consent.

1.Name of child……………………………………………………………………………

2.Address………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………….……
……………………………………………………………………………………………………………….

Home Tel No... ................. ...... ................ Mobile no…………………………………………………….......

Age………………………………………..Date of Birth………………………………………


Emergency Contact / Telephone (if different from above)

Name/Number……………………………………………………………..
Name/Number... ......... ................. ............................................. ……….

3. Personal Information:
Circle the answers below. Please give details requested below or personal information which
might be relevant on the back of the form if necessary  .

A) Does your child suffer from allergies, diabetes, migraine, epilepsy, asthma or any other illness or
disability?
YES/NO If yes, give details... ... ... ... ... ... ... ... ... ... ...'... ... .........................................

B) Is he/she allergic to anything e.g. antibiotics, elastoplast, aspirin or any such medicines, any
particular food/drink?
YES/NO If yes, give details.............................................................................................

C) Is he/she actively sensitive to penicillin?
YES/NO If yes give details……………………………………………………………….

d) Is he/she receiving any medical treatment at present?
YES/NO If yes give details.............................................................................................


F) Does he/she have any special dietary needs?
YES/NO If yes, give details………………………………………………………………

G. Can he/she swim 50 metres? This is a guide for us of your child’s ability
YES/NO

H) Name and address of own Doctor & Tel.No………………………………………………………

PLEASE RETURN THIS FORM WITH MEMBERSHIP FORM TO JEANNE BARSCH OR LYNN BOWDEN



                                                                                                                    NIPPER/JUNIOR/YOUTH 2009
                                  Perranporth Surf Life Saving Club
                                        The Use of Images of Children

Dear Parent
There are sometimes occasions when we wish to take photographs or make video recordings of
children at our Club. Sometimes this is for strictly educational and training purposes. On other
occasions it may be for other purposes e.g. taking photographs for use in the Club newsletters,
the Club web site, for Publicity situations such as newspaper articles or to use recordings of the
children on television when reporting or covering events we attend or hold.
In order to comply with the Data Protection Act 1998, the Club needs your consent before taking
photographs or making video recordings of your child for purposes which are not part of its core
activities. We should therefore be grateful if you could answer the following questions, sign and
date the form and return it as soon as possible.

NAME OF CHILD :......................................................................(child is anyone under the age of 18)

Please CIRCLE as appropriate

1). I agree that the Club can take photographs of my child which may be used in Club literature
(e.g. the Club's newsletters; the Club's brochure and other promotional material etc.).
YES/NO

2). I agree that the Club can use images of my child on its website.
(Please note the web site can be viewed across the world.)
YES/NO

3). I agree that the Club can use images of my child in video recordings to promote the Club.
YES/NO

4). I agree that the Club can take photographs and make video recordings of my child for the
Club's own records, archives and future interest (e.g. photographs of sports teams).
YES/NO

5). I agree that my child can appear in video recordings or in collections of photographs stored
on CD roms which the Club may make of Club events and which it may sell to parents of
children     at   the    Club   to    raise   funds   for    the    benefit     of  the    Club.
YES/NO

6). I am happy for the press to take and use images of my child.
YES/NO


7). The Club may give the press the first name only / first and surname (delete as appropriate) of
my child for publishing with the child's photograph in a newspaper or for captioning on television.
YES/NO
I have read and understood the conditions of consent


Signature parent/guardian……………………………………………………Date………………………

Name (in block capitals)……………………………………………………………………

Please return with Membership form to Jeanne Barsch or Lynn Bowden


Perranporth Surf Life Saving Club                                                 Home/Club Agreement

                                                                                                  NIPPER/JUNIOR/YOUTH 2009
                                Nipper & Juniors 16yrs and under to sign
                         Please sign and return 1 copy to Jeanne Barsch or Lynn Bowden

   The Club – we will:
           Care for the children's well being while they attend club sessions/competitions.
           Give the best training & water safety education we can.
           Encourage all children to work towards their true potential.
           Provide all relevant & appropriate information relating to the running of Nippers & Juniors.
           Inform parents of any problems or concerns about their child.
           Inform parents immediately of any untoward behaviour which affects the smooth running of any
            club session and take appropriate action if necessary.
           Regularly inform parents of their child's progress.
        
   Nipper Coach Signature……………………………………………………….

   Family - we will:
           Provide relevant emergency contact details/photo permissions
           Take responsibility for dropping off/picking up our child to/from the club or other organised
            sessions, unless alternative club transport is arranged.
           Ensure that our child arrives on time at the club properly equipped and ready for activities.
           Support the Club’s policies/guidelines for discipline & behaviour
           Inform the Club of any problems or concerns about our child.
           Endeavour to attend competitions & fundraising events and support our child’s participation in
            club life.

   Parent / Guardian Signature…………………………………………………

   The Child – I will:
           Arrive on time at all sessions and attend regularly.
           Wear correct club uniform and always wear my club hat in the sea.
           Do my best in club activities and competitions.
           Treat the Club Coaches and fellow club members with respect.
           Behave as best as I can and understand the club rules for bad behaviour.
           Think of my team members and not just myself.
           Have fun and enjoy myself

   Child’s signature……………………………………………………………….

BEHAVIOUR POLICY In the instance of serious misbehaviour we have a club policy of 2 “time out’s”,
(removed from activities) at the beach/club/swim session. If a child exceeds this then we may enforce a 2
week ban from club activities following discussion with both child and parents.The Club feel this is the best
way to deal with misbehaviour during a session.We have a responsibility to all our Nipper/Junior Members whilst at
the club and we feel it is not fair to waste time and valuable attention on children who misbehave to the detriment of
other members. We ask that all parents/carers support this policy. We will inform parents immediately of any action
taken.          PLEASE RETURN THIS FORM WITH MEMBERSHIP FORM




                                                                                         NIPPER/JUNIOR/YOUTH 2009
          MEMBERSHIP APPLICATION
                  2009


CLUB (if applicable)

PERSONAL                                                                                                 <SLSA_No          (Renewal
                                                                           Membership No                                   only)
DETAILS                                                                                                  >

                                                          FIRST
SURNAME                 <LASTNAME>                        NAME
                                                                              <FIRSTNAME>                     TITLE

SEX           Male/Female<Sex>                            DATE OF BIRTH              <DD><MM> <YY>

ADDRESS
                                                                                   POSTCODE               <Post_Code>

TEL NO:                 HOME         <Home_Phone>                         WORK
FAX:                    HOME                                              WORK
                        MOBILE       <Mobile>                             EMAIL         <Email_Address>

MEMBERSHIP CATEGORY

Nipper                     Junior                    Senior                  Life Member                   Personal Accident Insurance
(7 – 12 years)             (13 - 15 years)           (16 years & up)                                       (Optional)
                   st
All ages as of 1 January

AWARDS

Please list all awards held and expiry date (if relevant) – attach separate sheet if necessary
Award & Number                        Expires               Award & Number                  Expires




   DECLARATION

Permission is given for the above details to be entered on the SLSA of GB database and distributed in accordance with the Data Protection
Act 1984.

All members are covered by the Association’s Public Liability (up to £2 million), Personal Accident and Loss of Income are optional. This
insurance covers incidents that occur whilst the member is involved in any aspect of life saving or lifeguarding and is acting within his/her
qualification. The following qualifications are not valid unless a current member of the SLSA of GB: Instructor / Assessor / Coach / Official /
Referee.

I would like the SLSA of GB to reclaim the tax on any donations or membership subscriptions that I make. I have paid an amount of UK
income tax or capital gains tax equal to any tax reclaimed.

I agree to abide by the rules of the club and the SLSA of GB
(parent/guardian)                                                                            Signature

                                                                                             Date



  CLUB USE

Date application                                  Fee     £                   Signature of Club Officer
Received                                      received



                                                                                                          NIPPER/JUNIOR/YOUTH 2009
NIPPER/JUNIOR/YOUTH 2009

				
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