A(For Students)

INDIAN INSTITUTE OF TECHNOLOGY DELHI

BOARD FOR SPORTS ACTIVITIES

Swimming Pool Membership Form

Name Entry No.

Father’s Name

Department

Age Sex

Knows swimming (Write Yes or No)

Hostel Room No.

Mobile No.

Preferable slots: (write one for 1st preference, two for 2nd preference, etc.)

Tue./Thu./Sat. Wed./Fri./Sun.
6:00 to 7:00 AM 6:00 to 7:00 AM
Tue./Thu./Sat. Wed./Fri./Sun.
7:00 to 8:00 AM 7:00 to 8:00 AM
(only for females)
Tue./Thu./Sat. Wed./Fri./Sun.
8:00 to 9:00 AM 8:00 to 9:00 AM

Tue./Thu./Sat. Wed./Fri./Sun.
5:00 to 6:00 PM 5:00 to 6:00 PM
Tue./Thu./Sat. Wed./Fri./Sun.
6:00 to 7:00 PM 6:00 to 7:00 PM
Tue./Thu./Sat. Wed./Fri./Sun.
7:00 to 8:00 PM 7:00 to 8:00 PM

Emergency Telephone No

Residential Address
Medical Examination Report

A) (To be completed by the applicant)

Identification Mark

Blood Group

History of any of the following (If yes, Give details)

Epilepsy

Bronchichial Asthma

Heart Disease

Diabetes

Hypertension

Psychiatric Problem

Whether suffering from Eye infection

Ear Discharge

Skin Disease

Whether using (i) Spectacles (ii) Contact Lenses

Specify any known Allergy

(Sig. Of Student)

(A) To be completed by Medical Officer

I have examined Prof./Dr./Mr./Ms..___________________________________ S/O,/

D/O,/ W/O________________________________ and certify that he/she is fit to join swimming
pool.

Signature of Medical Officer

Date Name with seal
 Pay Rs. ___________ as the swimming pool membership fee in the SBI, IIT Delhi
branch in the Vice-President, BSA A/c No. 10773569325. Please deposit duly filled
application form, photocopy of identity card, bank counterfoil and two stamp size recent
photograph in the sports office for the issue of the membership card.

Valid Up to ____________

Membership No. ____________

Day & Slot ______________________

(Sports Office) (Sports Officer)

 INSTRUCTIONS FOR SWIMMING POOL MEMBERSHIP

Certified that I have read and understood the above instructions and will follow the same.

1. Non-swimmers/beginners shall not cross the barrier rope put up to restrict them from going into
the deeper portion of the swimming pool.
2. Members must vacate the pool after their allotted time is over or on the instruction of the
lifeguards. Members will be allowed to swim only in the allotted time and session as mentioned in
their card.
3. Membership cards are not transferable. Misuse of card will lead to cancellation of membership and
disciplinary action.
4. Coaching by our lifeguards during swimming hours is not allowed.
5. A member suffering from any disease should not use the swimming pool. Members suffering from
skin disease/cough or cold will not be allowed to use swimming pool facility.
6. Any injuries/loss of life while availing the facility will be at the swimmer’s own risk.
7. Beginners must wear red cap while they are in the pool. Membership will be cancelled in case a
beginner is found without red cap inside the pool.
8. Children below Eight (8) years of age are not permitted in the main swimming pool.
9. Children below 12 years of age have to be accompanied by an adult.
10. No cash, mobiles or watches etc. should be brought to the swimming pool or changing rooms. In
case of loss the BSA staff on duty will not be responsible.
11. Ornaments like chain/ring/bangles are not permitted to be worn while swimming.
12. Ladies and persons with long hair must wear a cap while in the pool.
13. All members must be in proper swimming costumes while using the swimming pool. Sports
staff/Lifeguards may refuse entry to any member in swimming pool if they are not wearing proper
swimming costumes.
14. Members must take a shower bath before and after using the pool.
15. Members must wash their feet in the foot tub before entering the pool.
16. All members are required to deposit membership cards and enter his/her name and membership
number at the time of entry and exit in the register failing which entry may be refused.
17. Maximum of 100 persons are permitted in the pool at any time on first come first serve basis.
18. Medical examination by the institute medical officer (signature and seal) is compulsory for any
member to use swimming pool facility.
19. Swimming pool will be open only if life guards are present and water is fit for swimming.
20. Membership will be cancelled on any act of indiscipline or not abiding to the instructions given by
the sports staff or lifeguards.
21. Visitors are not allowed to enter in the pool deck area.
22. No eatables are allowed in the pool premises. No pets are allowed in the swimming pool
area/complex.
23. The pool will remain closed on every Monday.
24. . The minimum height of the children for availing kid’s pool should be at least 100 c.m./3.2
feet on the day of submission of the form.

Signature with date