Form For Admission To The Swimming Centre
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1
2ADMISSION FORM
11672/DSO(UT)—Item 4—Govt.Press.UT, Chd.
SPORTS DEPARTMENT: CHANDIGARH ADMINISTRATION
ALL WEATHER SWIMMING POOL/ SWIMMING POOL, NURSERY CENTRE, SECTOR‐23, CHANDIGARH
FOR OFFICE USE
: Card No.__________________Receipt No._________________
Dated____________________Amount____________________
Name of the Applicant__________________________________
1.
Affix passport size photograph
duly attested by Head of
2.
Name of the Institution/Deptt.___________________________
Institution / Principal / Gazetted
Officer
3.
Date of Birth_________________________________________
4.
Father’s Name & Occupation____________________________
5.
Mother’s Name & Occupation________________________________________________________
6.
Address ( a)Permanent_______________________________________________________________
(b)Correspondence_________________________________________________________________
7.
Enrolment as member/regular trainee as student or non student____________________________
8.
Membership (Fee paid) Rs.___________________________________________________________
9.
It is certified that I have gone through the rules and regulations (overleaf) for the game of Swimming and
would abide by them.
10.
It is further certified that (i) I have the background of swimming
(ii) I have no background of swimming
(iii) I am taking the same at my own risk and responsibility
Signature of the applicant
Counter signature of the Father/Guardian
Recommendation of the Head of the institution / Department
Certified that applicant is a bonafide student / employee of this School / College / Office/ Organization
and all particulars given by him / her are correct according to the office record. The application is forwarded for
enrolment as member / trainee as student or non – student.
Signature of Head of the
Institution/Deptt. with seal
Certificate from the Registered Doctor / Practitioner (MBBS).
It is certified that he / she is not suffering from any communicable Disease
and fit for swimming.
Signature____________________
Name_______________________
Registration No._______________
Address/Seal_________________
Recommendation by the Coach
Signature
Countersignature by DSO
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