Diocesan Girls' School

Diocesan Girls' School

Aquatics Club Membership

Please submit your completed and signed membership application form, together with one 40mm (width) X 50mm (height) photo of the applicant (and of each family member where applicable, name at the back), one self-addressed and stamped envelope and a crossed cheque for the 2015-2016 membership fee payable to "Diocesan Girls' School".

The membership fees for the period September 2015 to August 2016 are:

HK$200 - Individual membership for our student

HK$500 - Individual membership for an immediate family member of our student

HK$500 - Individual membership for a DOGA member

HK$800 - Individual membership for a non-DOGA member alumna

HK$1200 - Current student's and DOGA member's family membership for a total of 4 persons

HK$1500 – Non DOGA member alumna's family membership for a total of 4 persons

HK$100 - Individual membership only for swimming team member (please confirm with teacher in-charge)

For all family membership applications, an additional HK$500 will be charged for every additional person.

This application form, photos, self-addressed and stamped envelope and crossed cheque to be submitted to:

Apply for DGS Aquatics Club Membership

Diocesan Girls' School

1 Jordan Road

Kowloon, HKSAR.

Your application will be processed upon receipt of your membership fee and a membership card will be mailed to you or delivered to the student (where applicable) in 4 to 8 weeks. Your membership will become effective upon issuance of your membership card(s).

Only members of the DGS Aquatics Club are eligible to enroll for swimming classes to be held at the DGS pool during non-school hours. For members who are 12 years of age or under and who are not attending swimming classes, she will not be permitted to use the pool unless accompanied by a responsible member 18 years of age or older.

Diocesan Girls' School

Aquatics Club Membership Application Form 2015-2016

(Please complete in ENGLISH Block Letters)

Application for

Individual Membership (Student) HKD200

Individual Membership (Immediate Family) HKD500

Individual Membership (DOGA Member) HKD500

Individual Membership (non-DOGA Member alumna) HKD800

Family Membership (of Student / DOGA Member) HKD1200

Individual Membership (Swimming Team Member) HKD100

1)  Principal Member (Student or Alumna):

Title*: Miss Mrs. Dr. Ms. Other: ______

Surname: ______Other Names in Full: ______

Past Aquatics Club Membership Number if applicable: / - / - / -

2)  A) For 2015-2016 P1-S6 Students Only:

Class: ______Class No.: ______Name of Parent / Guardian: ______

B) For Alumna only:

DGS Class of: ______(i.e. the year you were / would have been in Form 5 / Secondary 6)

DOGA Member Number: ______(in the absence of valid DOGA membership, non-DOGA member fees for DGS Aquatics Club will be charged)

ONLY for alumna that is below age 18 to fill in – Date of birth: ___/ ____/ ____ (dd/mm/yyyy) Age: ___

3)  Affiliated Family Members (of the same household):

Surname / Other Names in Full / Gender / Age / Date of Birth (dd/mm/yyyy) / Relationship with Principal member *
(i) / □ M/□ F / dd/mm/yyyy
(ii) / □ M/□ F / dd/mm/yyyy
(iii) / □ M/ □ F / dd/mm/yyyy
(iv) / □ M/ □ F / dd/mm/yyyy

If any of the affiliated family members is our alumna, please also provide the following: (*DGS reserves the right to

Name: ______require supporting

DGS Class of: ______(i.e. the year you were / would have been in Form 5 / Secondary 6) documents for declared

DOGA Member Number: ______(if you are a member) relationship)

Home Address

Flat / Room / Floor / Block
Name of Building
Name of Estate / Number and Name of Village
Number and Name of Street / Lot Number
Area and District Name
Mobile Phone Number / Home Telephone Number
E-mail Address

4)  In Case Of Emergency, Please Contact:

Surname: ______Other Names in Full: ______

Relationship with Student or Alumna: (______) Telephone number:______

Aquatics Club members who have duly paid membership fees and carry a valid membership card will be entitled to use the DGS swimming pool from 1st September 2015 to 31st August 2016, during opening hours. No rebate will be given in respect of any paid membership fees as a result of early termination or suspension of membership for whatever reason.
By signing below and returning your application to Diocesan Girls’ School, you agree to abide by, and will procure your affiliated family members to abide by, the DGS Aquatics Club Rules and Regulations as may be amended from time to time as if the same were fully set out in this Application Form. Your attention is also drawn to the Personal Information Collection Statement at the end of this form.
Pool opening hours for registered members:
1st September 2015 to 30th November 2015
Weekdays except public holidays --- 4:00 p.m. to 6:00 p.m.
Saturdays except public holidays --- 8:00 a.m. to 6:00 p.m.
Sundays -- 8:00 a.m. to 4:00 p.m. / 1st April 2016 to 31st August 2016
Opening hours to be confirmed
The pool will be closed on all public holidays except most Sundays. As the pool may be closed on certain Sundays, members are encouraged to refer to the DGS website for details on pool opening dates before their arrival. The School further reserves the right to close the pool for special activities, periodic cleaning, maintenance and check-up, in which case details will be posted at the pool entrance.
I understand that the use of DGS swimming pool and any facilities and equipment therein through Aquatics Club is undertaken at the applying member and her affiliated family member’s (where applicable) own risk. I hereby agree to waive any and all rights which I or my affiliated family members may have against Diocesan Girls’ School, Diocesan Girls’ Junior School and its affiliates, staff, students, advisers and agents arising from any death, personal injury, damage, loss, cost expense, or inconvenience which an applying member(s) hereunder may suffer to incur arising from my or his/her use of any facilities and/or equipment provided by Aquatics Club, Diocesan Girls’ School or Diocesan Girls’ Junior School. Furthermore, I undertake to bring the provisions of this Clause to the attention of my affiliated family members (where applicable). I shall indemnify and keep Diocesan Girls’ School and Diocesan Girls’ Junior School and its affiliates indemnified from and against any and all liabilities, costs and expenses and agree that this indemnity will continue to apply notwithstanding that the applying member may cease to be a member of Diocesan Girls’ School or Diocesan Girls’ Junior School for any reason whatsoever.
5)  Signatures:
For category 2A : Signature and name of Parent / Guardian:
Name:
For category 2B : Signature and name of Alumna: For category 2B : Alumna age below 18 is required to provide
the signature and name of her parent

Name: Name:
For category 3 : Additional signatures and names of all other family members who have attained the age of 18:
______
(i) (ii) (iii) (iv)
Date of Application:

Personal Information Collection Statement:
Any personal data collected and recorded in relation to an applicant by Diocesan Girls’ School will be considered private and confidential. Your personal information will only be used for processing and managing your membership and activities pursuant to the membership; otherwise no applicant’s personal data will be disclosed to any unauthorized party outside the Aquatics Club Membership management of Diocesan Girls’ School, unless Diocesan Girls’ School is satisfied that the applicant has consented to the disclosure.

DGS Aquatics Club Membership Application Form 2015-2016

Latest update: 05/05/2015