ofsc Family Swim club Form 2016-2017 SEASON

MEMBER APPLICANT 1
MEMBERSHIP TYPE
(Select One) / ☐ Squad Swimmer – Competitive / Friday Night Point-Score and / or Club Carnivals
☐ Squad Swimmer – Non Competitive / General Fitness / Surf Life Saving / School Carnival
Surname:Click or tap here to enter text. / Given Names:Click or tap here to enter text.
Date of Birth:Click or tap to enter a date. / Age: / Gender: Choose gender
Medicare Number:Click or tap here to enter text. / Expiry:Click or tap to enter a date.
Medical Conditions/Allergies:Click or tap here to enter text.
MEMBER APPLICANT 2
MEMBERSHIP TYPE
(Select One) / ☐ Squad Swimmer – Competitive / Friday Night Point-Score and / or Club Carnivals
☐ Squad Swimmer – Non Competitive / General Fitness / Surf Life Saving / School Carnival
Surname:Click or tap here to enter text. / Given Names:Click or tap here to enter text.
Date of Birth: Click or tap to enter a date. / Age: / Gender: Choose gender
Medical Conditions/Allergies:Click or tap here to enter text.
MEMBER APPLICANT 3
MEMBERSHIP TYPE
(Select One) / ☐ Squad Swimmer – Competitive / Friday Night Point-Score and / or Club Carnivals
☐ Squad Swimmer – Non Competitive / General Fitness / Surf Life Saving / School Carnival
Surname:Click or tap here to enter text. / Given Names:Click or tap here to enter text.
Date of Birth:Click or tap to enter a date. / Age: / Gender: Choose gender
Medical Conditions/Allergies:Click or tap here to enter text.
MEMBER APPLICANT 4
MEMBERSHIP TYPE
(Select One) / ☐ Squad Swimmer – Competitive / Friday Night Point-Score and / or Club Carnivals
☐ Squad Swimmer – Non Competitive / General Fitness / Surf Life Saving / School Carnival
Surname:Click or tap here to enter text. / Given Names:Click or tap here to enter text.
Date of Birth:Click or tap to enter a date. / Age: / Gender: Choose gender
Medical Conditions/Allergies:Click or tap here to enter text.
PARENT / GUARDIAN DETAILS (applicable if swimmers are under 18 years)
Surname:Click or tap here to enter text. / Given Name:Click or tap here to enter text.
Street Address:Click or tap here to enter text.
Suburb:Click or tap here to enter text. / Post Code:Click or tap here to enter text.
Contact Numbers: / Mobile:Click or tap here to enter text. / Home:Click or tap here to enter text.
Email Address: / Primary:Click or tap here to enter text.
Secondary:Click or tap here to enter text.
Preferred Method of Contact for Billing / Invoice Enquiries:
ALTERNATE EMERGENCY CONTACT
Name:Click or tap here to enter text.
Primary Contact Number:Click or tap here to enter text.
Alternate Contact Number:Click or tap here to enter text.

ONTH

MONTHLY LANE HIRE FEES FOR 2016/2017 SEASON
NUMBER OF FAMILY SWIMMERS / MONTHLY LANE HIRE FEE DUE
1 / 70
2 / 110
3 or more / 145
PLEASE NOTE:
Monthly Lane Hire Fees are due by the beginningof the month you intend to swim.
Please refer to our OFSC Lane Hire Fee Policy on our website for more information.
MONTHLY LANE HIRE FEE PAYMENT OPTIONS
Electronic Funds Transfer / Over The Counter Bank Deposit
Bank: Bendigo Bank
BSB: 633-000
Account Number: 111387536
Account Name:
Oak Flats Swimming Club
Reference Name:
Please enter your full name in capital letters. /
Cash or Cheque Deposit at any Bendigo Bank
You must ensure the teller enters your full name when you deposit as detailed below
Bank: Bendigo Bank
BSB: 633-000
Account Number: 111387536
Account Name: Oak Flats Swimming Club
Reference Number:
Please enter your full name in capital letters.
DECLARATION
I, the undersigned, acknowledge that it is a condition of acceptance of my Family Swim Form that:
  • I authorise Oak Flats Swimming Club to allow Shellharbour City Council (Oak Flats Pool) staff to administer First-Aid and organise medical or Hospital treatment as they see necessary.
  • I agree to abide by the rules, regulations and policies of Oak Flats Swimming Club and Swimming New South Wales, Swimming Australia Ltd, the relevant Area Swimming Association and the relevant club including Swimming Australia's Anti‐Doping, Member Protection, Child Welfare and Privacy Policies.
  • I agree to abide by the Oak Flats Swimming Club and Swimming Australia Ltd Code of Conduct.
  • I authorise the club to publish suitable photographs taken of me or my child and results in official programs, newsletters, club website, club social media or any other Oak Flats Swimming Club produced documents.
  • I will assist and support the committee and coaches of the Club wherever possible to ensure that the Club continues to run smoothly and achieve its objectives.
  • I give permission to the coaching team to conduct fitness training for members listed in this form, at a suitable and safe location.
  • I will participate in the activities of the Club, including but not limited to:
  • assisting in volunteer duties (e.g. time-keeping) allocated to the Club at approved meets;
  • assisting in the running of Club nights/days; and
  • assisting in official Club fundraising activities.
  • I understand that when I or my child competes in a swimming event that I am / they are representing the Club and should be attired in the correct club uniform.
  • I agree that all Parents / Guardians must take responsibility for the supervision of their children at training, club point-score nights and approved meets.
  • I agree that OFSC Monthly Lane Hire Fees must be paid by the beginning of the month you intend to swim, whether or not the above mentioned swimmers swam the full month or not and agree to make these payments by the due date or to make arrangements with the Treasurer of Oak Flats Swimming Club in regards to alternative payment arrangements.
  • I agree I am liable for all outstanding Lane Hire Fees the above named swimmers have incurred, whether they are still swimming with Oak Flats Swimming Club or not.
  • I agree to accept and pay the above quoted Monthly Lane Hire Fees and acknowledge these fees can be changed by Oak Flats Swimming Club during the 2016/2017 season and seasons proceeding the signing of this OFSC Family Swim Form.
  • I authorise Oak Flats Swimming Club to contact the undersigned by telephone, mail or electronic messages (including email).

Signature:Click or tap here to enter text. Type your full name to accept the above declaration
Name:Click or tap here to enter text. / Date: Click or tap to enter a date.

NE HIRE FEES FOR 2015/2016 SEASON