Please complete as much of this form as possible. Ensure that you read the declaration thoroughly, with special focus on the use of this information for club and wider purposes.
Select type of Membership
New membership to this club
Transferring my primary membership from another club
If transferring, from what club?
Personal Details of swimmer
First Name (required)
Middle Name (as required)
Date of Birth - please type in the date in the format dd/mm/yyyy
Please select your ethnicity
New Zealand European
Cook Islands Maori
Other Pacific Peoples
Please enter at least one primary contact (the Club would prefer two, but recognises this is not always possible.
Please ensure that you update the club should primary contact details change in the future, thank you.
First Name (required)
Phone 1 (required)
Phone 2 (optional)
email 1 (required)
Please indicate any areas that may be of benefit to the club
(For example: qualified IOT; director on boards; relevant work experience.)
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:
Learn to swim
Please read the
, check the box and submit.
I declare that all information supplied on the application for membership form is true and correct.
I will keep my address and all other personal information up to date on the Swimming NZ website by using the personalized login and password provided, or by immediately notifying in writing of any changes.
I am not aware of any reason why I should not be issued with the membership requested;
I understand that upon payment of my membership fee (if any) I will become a member of the club, the region and Swimming NZand 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:
As a member I will abide by the constitutions, regulations, policies, manuals, guidelines and reasonable directions of the club, the region and Swimming New Zealand and FINA respectively.
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
As a member I will comply with the anti-doping policies of Swimming NZ, World Doping Agency and Drug Free Sport New Zealand.
I understand that I may terminate my membership with immediate effect by giving notice at any time
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:
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;
Determine the exact number and categories of the members of the club, the region and Swimming NZ;
Determine the membership fee payable by the club, the region and Swimming NZ;
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;
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;
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.
Any other purpose I agree to in writing.
I agree to be filmed, televised or photographed and otherwise recorded at training or during a competition or swimming event which material may be used by the club, region or SNZ for publicity purposes during and after my membership expires.
I understand images of members may be used on SNZ’s websites from time to time and I may request at any time that an image including myself be removed from the website which will be done so at SNZ’s earliest convenience.
I agree to pay all club fees, levies and dues attributable to our membership.
I understand if fees are not paid on time I may be asked not to swim until the debt is paid.
If I leave the club during the membership period I understand I will be eligible for any unpaid fee and will not receive a refund.
I understand that my personal information will only be used for the purposes listed in paragraph 4 and that:
My personal information will be held securely;
I will have access to my personal information;
My personal information will be corrected upon request;
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.
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.
Nothing in these terms will affect my statutory rights as a consumer
9. Conditions of Membership:
To enable the club to run efficiently we need parental help. Submitting this form acknowledges that requirement and that you are agreeing to help from time to time. Copies of the constitutions of the club, region or Swimming NZ can be obtained by contacting your club, region or Swimming NZ. Please check the website first.
I have read and I consent to the Membership Declaration or if the member is under 18 yrs, 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/their personal information in accordance with clauses 4 and 5 of the membership declaration.
Check to confirm acceptance
If you have any further queries please email
Report any issues with the form to
Raptors IT / website support