Membership Form If you are human, leave this field blank.Page BreakMEMBERSHIP DETAILSMembership Application *Are you joining for the first time or are you renewing your club membership? i.e. have you been a registered member of RLSS Poole Lifeguard in the past? NEW MEMBERSHIP RENEWALMembership Number *This is the Membership Number shown on your renewal slip. If you do not know your Membership Number then send an email to membership@rlss-poole.org.uk requesting it. If you are joining for the first time then select "New Membership"Membership Year *Select the year that you are applying for club membership - Membership year is 1st Jan to 31st Dec2025Membership Type *Individual MembershipFamily MembershipMembership Fee *Full MembershipReduced Membership if applying between 01st Sep to 30th NovCategory *Those under 18years of age on 1st Jan are Juniors for that year.Senior - full year £50Junior - full year £40Supporter - full year £30Life Member - full year £0.01Guest Member £5Family Membership Fee (Full Year) *Those under 18 yrs of age on 1st Jan are Juniors for that year. A separate Membership Form MUST be completed for each family member Family Membership Full Year - full year £100Senior - Part of Family Membership - £00.01 Junior - Part of Family Membership - £00.01 Category *Those under 18years of age on 1st Jan are Juniors for that year.Junior Family MemberSenior Family MemberSupporter Family MemberCategory *Those under 18years of age on 1st Jan are Juniors for that year.Senior - 01st Sep - 30th Nov £25.00Junior - 01st Sep - 30th Nov £20.00Supporter - 01st Sep - 30th Nov £15.00Guest - 01st Sep - 30th Nov £5.00Family Members *List the name of the applicant who has paid the "Family Memership" fee.Family Members *List the names of your familly members to be included in the "Family Memership" fee. Remember to complete a membership form for each family member. Page BreakFREE CLUB T-SHIRTAnybody joining our club for the first time is entitled to a free RLSS Poole Lifeguard Club T-shirt. Therefore please select the 'Style of Tshirt' followed by the 'Size' you would like. T-Shirt Style *Junior T-Shirt - Age 9 -16Senior T-Shirt - Age 17 upwardsT-Shirt Size *Chest 36inchChest 38inchChest 40inchChest 44inchChest 46inchChest 48inchNo Thank You!Junior T-Shirt Size *Chest 28inchChest 30inchChest 32inchChest 34inchNo Thank You! MEMBER DETAILSName *Name of person joining the clubAddress *Address of club memberCountryUnited States (US)United Kingdom (UK)CanadaAustralia---AfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweCityStateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin IslandsZip codeE-mail address *Members Email AddressConfirm Email AddressHome PhoneEx-Dir (Home)YesMobile Phone No. *Members Mobile NumberConfirm Mobile No.Ex-Dir (Mobile)YesDate of Birth *Age *Age on the 1st January for the year that you are paying your membership fee.Medical Ailments *Do you have you any medical ailments that we as a club should be aware of? NoYesAilment Details *If your answer is \'YES\' please enter details of your ailments (Confidentiality will prevail) Please also note: that it is your responsibility, to update RLSS Poole Lifeguard of any ailments should your circumstances change during the year!Notify UsDo you agree to update RLSS Poole Lifeguard, should your circumstances change, during the membership year!I agree to update RLSS Poole of changes Page BreakDISCLAIMERS1) I the undersigned apply for membership of RLSS Poole Lifeguard 2) I agree to abide by the Constitution and Rules of the Club (copies may be obtained from the Hon Secretary on request). 3) I understand that the Club is fully committed to safeguarding the well-being of all its members, particularly children, and that all member are expected to show respect and understanding for the rights, safety and welfare of others, and conduct themselves in a way which reflects the principles of the Royal Life Saving Society UK. 4) The Club expects members, instructors and trainers and parents to deal with each other with respect. Parents/Guardians agree to remind their children that disrespectful behaviour toward our volunteer instructors and officers is not acceptable and may result in their child being removed from a training session or being asked to leave the club. 5) I also understand that my membership is renewable on an annual basis, and that it will be due, during the month of December, for the following calendar year.Club Disclaimer *I Understand and AgreeI dont agreeNon Agreement *Please enter what you do not agree with, and we will get in contact with you and discuss whether we can continue to process your application for club membership. Be assured that confidentiality will prevail. Please note: that if you select "No I don't Agree" and do not enter the reasons in this field, your membership application will not be processed. PUBLICITY PHOTOSOn occasions we take photographs of our club members and their activities / achievements for use as publicity/promotions for the club and it’s aims. Do you give permission for photographs that may contain images of you, or your child, to be used for such purposes, eg on our club noticeboard, website, social media and or press to promote the clubs activities.Photos *I give permissionI do not give permission I give permission so long as the identity is obscured CRIMINAL OFFENCES6) Applicants are advised that under regulations made under the Rehabilitation of Offenders Act 1974, you should declare all relevant matters including \'spent convictions\'. This however does not include speeding, careless driving, depositing of litter or other matters which might reasonably be regarded as minor. If in doubt, please speak in confidence to the Chairman/Hon Secretary before answering this question. This information is required because as a trainee Lifesaver/Lifeguard you will be working with children and young people).Offences *Have you ever been convicted of a criminal offence or been the subject of a caution or a bind-over order?NoYesNotify UsYou agree to update RLSS Poole Lifeguard, should this change, during the membership year!I agree to notify PLG of any releavent changes.Details Of Offence(s) *Please state the nature and dates of the offence(s). GIFT AIDIf you are a UK Tax Payer, as a Charity , RLSS Poole Lifeguard is eligible to recover 25p for every £1 donated via donations or club membership from the HMRC as a ‘top up’ to your donation /membership fee.Tax Payer *Are you, as either the paying Member above 18yrs of age or the Parent / Guardian making payment, a registered tax payer ?YesNoGift Aid *I confirm that all donations / membership payments I make to RLSS Poole Lifeguard from this date until further notice should be treated as Gift Aid donations and I would like RLSS Poole Lifeguard to reclaim the Gift Aid on my donations / membership fee.YesNo PERSONAL DATA As part of your membership application, your details will be added to the Club database. These details are used solely for club purposes and are not given out to third parties. Your details are used to communicate the occasional club notice and or club E-Newsletter to you. On receipt of the E-Newsletter you will have the option to unsubscribe from it should you so wish. We will also use SMS messaging and social media apps as tools to communicate information to and from members and Parents/guardians about the day to day running of the club Personal Data *I understand DECLARATIONBy signing the Member Signature Field below, you declare that the information that you are about to submit in this online form is correct and true and consent to Poole Lifeguard Club processing my data in accordance with currently accepted GDPR protocols. RLSS Poole Lifeguard Club complies fully with the requirements placed on us by UK GDPR, the Data Protection Act and RLSS UK Qualifications in relation to the handling, storage and sharing of data. Details of how the club comply with the current UK GDPR regulations can be found at www.rlss-poole.org.uk/wp-content/uploads/2022/03/privacy-protection-policy-plg-v2.pdfForm Data *The data provided in this form is accurateParent / Guardian Name *Name of Parent or Guardian if applicant is under 18 years old.Parent / Guardian Email *Parent or Guardian Email if applicant is under 18 years old.Confirm Parent or Guardian EmailParent / Guardian Mobile No. *Parent or Guardian Mobile No. if applicant is under 18 years old.Member Signature *Member Signature or Parent / Guardian Signature if applicant is under 18.Date of Application *todays date FORM SUBMISSION Many thanks for taking the time to complete this form. NOW Press the SUBMIT button ONCE and then wait for the PayPal screen to appear to enable you to make payment and complete your membership application. NOTE: If the PayPal screen does not appear after you have clicked Submit, follow the link below to make a manual payment. Go to MANUAL PAYMENT METHOD Captcha *For security verification, please enter any random two digit number. For example: 91Submit Form