2020 Guardian Consent Form Wiveypool

Registered Charity Number: 1085807
Consent Form

Permission for Junior Day Members (12 - 15 yr old) to swim at Wiveypool
Legal Guardian Consent *

I give my consent for the juniors named below to attend the Wiveliscombe Community Swimming Pool Club & confirm that they are 12 years old or older
Legal Guardian name *

First Name Last Name
Relationship to child/children *
Emergency contact number *
Please do not leave a blank space in the number
Emergency email
Name of Junior day member

To attend without an adult in attendance juniors must be aged between 12-15 years
Junior Day Member *

First Name Last Name
Date of Birth *

Day Month Year
Junior Day Member

First Name Last Name
Date of Birth

Day Month Year
Junior Day Member

First Name Last Name
Date of Birth

Day Month Year

View Pool Rules & Code of conduct
Pool rules & Code of conduct *

I have read understood and accept the pool rules and code of conduct and affirm that the juniors included in this day membership form agree to be bound by them.
Notification of medical conditions *

I agree on behalf of the juniors in this form, that they will inform the lifeguard/pool attendant on duty of any medical condition which may cause concern during physical exercise.
Liability *

I understand and accept that, although the club does provide a qualified lifesaver, all members enter the pool and its premises at their own risk and that no responsibility for loss, damage or accident howsoever arising, will be accepted by the club, committee or its members.
Pool rules and code of conduct can be found on the website wiveypool.org

Annual membership rates 2020 season

Adult (>18 yrs) £50

Junior & Students (3-18 yrs) £40

0 - 2 years free

Family membership: all juniors/students £20 with any full price

membership (must live in the same household)
Should be Empty: