Registration 2009_2010 V3

KIWI WEST AQUATICS Application for Membership I am applying for membership of the Kiwi West Aquatics swimming club New membership to a Swimming New Zealand club Transferring my primary membership from _____________________________________ swimming club 1. MEMBERSHIP CATEGORY – PLEASE TICK ONE OF THE FOLLOWING Competitive Swimmer

Official

2. PERSONAL DETAILS I hereby apply for membership of the above mentioned swimming club, the clubs region and Swimming N.Z. Title:

Mr / Ms / Mrs / Miss / Dr / Other_____________

First Name:______________________ Male:

Middle: _________________

Female:

Surname:______________________

Date of Birth: ______/______/_______

Address:_________________________________________________________________________________ Suburb: _______________________________ City:___________________________ Postcode: __________ Phone: Home (_____)______________

Work: (_____)______________

Mobile: (_____)_____________

Email:________________________________________________________ 3. NEXT OF KIN 1

NEXT OF KIN 2

Title:

Title:

Mr / Ms / Mrs / Miss / Dr / Other____________

Surname: _________________Given:_____________

Mr / Ms / Mrs / Miss / Dr / Other____________

Surname: _________________Given:_____________ Address:____________________________________

Address:____________________________________ Suburb:_____________________________________ City:_____________________ Postcode:__________ Phone 1:(____)____________ 2:(____)___________

Suburb:_____________________________________ City:_____________________ Postcode:__________ Phone 1:(____)____________ 2:(____)___________ Email:______________________________________

Email:______________________________________ 4. INTERESTS From time to time the club, region and SNZ would like to circulate information to the membership. Please tick the box(es) if you wish to receive information on the following: General Updates

Swimmers

Coaching

Officials

Swim Schools

Administration

5. MEMBER DECLARATION I have read and I consent to the Membership Declaration (over page). Signature: _____________________

Date:______/______/_______

Under 18 yrs, parent, guardian, caregiver consent I am the parent/guardian/caregiver of the applicant who is under 18 years of age. I have read and understood this application form and the applicant’s membership declaration (over page). I understand the form and the declaration and I consent to the applicant’s application for membership on this basis. I also consent to the use of my personal information in accordance with clauses 4 and 5 of the membership declaration.

Surname:________________________________

First Name:___________________________________

Email:________________________________________________________ Signature: _____________________

Date:_______ /_______ /_________

CLUB USE ONLY Membership:

Accepted

Rejected

Date: _______ /_______ /_________

Membership category allocated: ____________________________ Signature of club officer: __________________________________

SNZ Registration No:______________________ SNZ Database No:____________________

KIWI WEST AQUATICS Membership Requirements

1.

2.

Club Membership Fees - $100 

Payment comprises of a $35 club fee and $65 Swimming Manawatu Levy



The annual registration period is from April 1st to April 1st the following year. at any time of the year but will still be charged for the full amount.



Payment for registration should be received before the club AGM in May for members to be eligible to vote.



Swimmers will not be entered into any swimming meets until the registration payment has been received.

Uniform Fee (Shirt & Cap) $55 

3.

The team shirt and cap is compulsory for club members, the club also have a range of other uniform items from time to time members can purchase

Training Fees/Coaching Fees 

4.

Swimmers may choose to register

All training/coaching fees are paid directly to the Nicholls Swim Academy who provides all of the clubs swim training. Please note this is a separate entity from Kiwi West Aquatics and all coaching and training enquiries should be directed in the first instance to the Nicholls Swim Academy

Transferring 

You will need to complete a transfer form which can be found on the Swimming Manawatu website http://www.manswim.org.nz/documents.html



All applications from another club require an interview with the club coach, Interviews can be organised through the Nicholls Swim Academy. You will need to complete a transfer form and provide a copy of your swimming times (Preferably a Team Manager File, this should be available from your current swimming club)

Name of Swimmer: ………………………………………………………………………………………………………………………………. If under 18yrs Parent/Caregiver to print name

Signature of Swimmer: ………………………………………………………………………………………………………………………. If under 18yrs Parent/Caregiver to sign Date

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Payment attached

Payment made online

KIWI WEST AQUATICS Membership Declaration 1. Declaration: (a) I declare that all information supplied on the application for membership form is true and correct. (b) I will keep my address and all other personal information up to date on the Swimming NZ website by using the personalised log in and password provided, or by immediately notifying in writing of any changes. (c) I am not aware of any reason why I should not be issued with the membership requested; (d) I understand that upon payment of my membership fee (if any) I will become a member of the club, the region and Swimming NZ and that by paying such fee each year by the due date, I will continue to be a member of my club, the region and Swimming NZ, unless I resign or my membership is terminated. 2. Other Rules: (a) As a member I will abide by the constitutions, regulations, policies, manuals, guidelines and reasonable directions of Kiwi West Aquatics Inc, Swimming Manawatu and Swimming New Zealand and FINA respectively. (b) As a member I will abide by the Swimming New Zealand code of conduct located on the SNZ website: www.swimmingnz.org.nz/about-us/snz-code-of-conduct and the club code of conduct located on the club website:www.kiwiwest.org (c) As a member I will comply with the anti-doping policies of Swimming NZ, World Doping Agency and Drug Free Sport New Zealand. (d) I/We agree the club may film or photograph at training, competitions or club events which material may be used by Kiwi West Aquatics Incorporated for publicity purposes during and after membership of Kiwi West Aquatics Incorporated expires. (e) Children are members of the club but parents will vote on their behalf at club meetings if under 18 years of age. 3. Termination: (a) I understand that I may terminate my membership with immediate effect by giving notice at any time (b) I understand that the club, the region or Swimming NZ may terminate my membership with immediate effect in accordance with the provisions relating to this in the Swimming NZ Constitution. 4. Your Personal Information: I agree to my club, the region and Swimming NZ, their employees, sub-contractors and agents using any personal information provided or otherwise held about me (whether or not related or pursuant to this contract) to: (a) Enable the club, the region and Swimming NZ to have a register of their members as required by section 22 of the Incorporated Societies Act 1908 and any other statute, regulation, by-law or other regulatory instrument that requires collection or disclosure of my personal information; (b) Determine the exact number and categories of the members of the club, the region and Swimming NZ; (c) Determine the membership fee payable by the club, the region and Swimming NZ; (d) Determine the interests and nature of the membership at club, region and national level for the purposes of determining which sponsor and/or stakeholders may be appropriate for my club, region and Swimming NZ; (e) Enable my club, region and Swimming NZ to communicate with me and other members about my membership and matters affecting my club, region and Swimming NZ such as their events, activities, seminars including communicating with me through newsletters, emails, texts and other electronic messaging and for this purpose to supply the information to mail houses; (f) Enable my club, region and Swimming NZ to contact me on behalf of sponsors and stakeholders for the purposes of promoting the sponsors or stakeholders products and services. (g) Any other purpose I agree to in writing. 5. I understand that my personal information will only be used for the purposes listed in paragraph 4 and that: (a) My personal information will be held securely; (b) I will have access to my personal information; (c) My personal information will be corrected upon request; 6. Liability: (a) I will not hold my club, region and Swimming NZ or their respective officers responsible for any claims, losses and expenses which may arise from or in connection with my membership and/or participation in any activity authorised or recognised by my club, region and Swimming NZ except in the case of gross negligence or a wilful act or omission on the part of my club, region and Swimming NZ. (b) I indemnify my club, region and Swimming NZ from all claims, losses and expenses suffered or incurred at any time, occurring as a result of or resulting directly or indirectly from my failure to observe the constitutions, regulations, policies, manuals, guidelines and reasonable directions of my club, region and Swimming NZ respectively. (c) Nothing in these terms will affect my statutory rights as a consumer Copies of the constitutions of the club, region or Swimming NZ can be obtained by contacting your club, region or Swimming NZ via www.swimmingnz.org.nz