Water Polo Championship
Sea Swim
Shop
Your Account

Shop

swim-group-registration-products-2018

Swim Group Member Sign Up

£0.00

Add a Lyme Splash T-Shirt (£20 each)
T-shirts will be posted a few days after the event, price includes P&P
Add Raffle Tickets (£1 each)
Registration includes: Entry to Lyme Regis to Charmouth Challenge, a hot chocolate drink, biscuits & Rib Ride from our sponsors, swim hat, scan tag, a Lyme Splash badge for completion of the swim & a chance to win one of eight delicious prizes from Dorset Chocolatiers Chococo. Check out the shirts and raffle tickets
Instructions
For swimmer registration, please fill in the form below then click 'Add to Basket' at the bottom of the form and go through the checkout process to pay.
Part A: Pre-Entry Review/Assessment

If you have had Covid in the three months before swimming and have been hospitalised or required oxygen please consult your doctor to confirm you are fit to swim and you will have needed to have swum at least 2k in open water before taking part.
Had COVID in the last 3 months and are fit to swim?*
If you have had Covid in the three months before swimming and have been hospitalised or required oxygen please consult your doctor to confirm you are fit to swim and you will have needed to have swum at least 2k in open water before taking part.
- Yes
- No
- NA
Have you swum in open water in 2023?*
- Yes
- No
Have you complted a 2km or more swim in the last four months?*
- Yes
- No
How long (approximately) does it take you to swim 1 mile (in or out of competition)?*
Please give answer in minutes
If you answer “no” to the questions above you will be automatically precluded from participating. A participant must be able to swim a minimum of ONE MILE non-stop and have swum this in open water in the previous Four Months.
Part B: Pre-Challenge Fitness Review
Has your doctor ever said you have a heart condition (such as coronary heart disease, congenital heart disease or vascular heart disease)?*
- Yes
- No
Do you feel pain in your chest, shortness of breath or dizziness when you undertake physical activity?*
- Yes
- No
In the past month, have you had chest pain when you are not doing physical activity?*
- Yes
- No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
- Yes
- No
Is your doctor currently prescribing drugs for blood pressure or a heart condition or do you take any medication that may affect you when taking part in physical exertion?*
- Yes
- No
Are you pregnant?*
- Yes
- No
Please can you indicate any disabilities?
Do you suffer from epilepsy?*
- Yes
- No
Do you suffer from diabetes mellitus and need to take insulin?*
- Yes
- No
Do you know of any other reason that may affect your ability to take part in physical activity?*
- Yes
- No
...If yes, please state why:
Have you answered YES to any of the questions in Part B?
If you answered yes to any question in part B you will need to have a have a Medical Referee to confirm you are fit to take part in Lyme Splash 2023.
Please download the form HERE

If you have completed this form and sent/will be sending it please indicate how:
- By email
- By post
Part C: Personal Information To Register
Firstname*
Lastname*
Date of Birth (dd/mm/yyyy)*
DD slash MM slash YYYY
Under 18?
If you are under 18 you will need consent from a Parent or Guardian
Please download form HERE

If you have completed this form and sent it please indicate how:
- By email
- By Post
Gender*
- Male
- Female
- Non-binary
- Prefer not to say
Address
Street Address*
Address Line 2
Town/City*
County
Postcode*
Country*
Email*
Mobile Phone*
Emergency Contact*
Name and phone number to contact in an emergency
To ensure you are placed in the right wave to swim please indicate an approximate swim time for 2 miles / 3.15 kilometres in open water*
Please give answer in minutes
Opt-in
Can we use your details to email you about events & news?
- Yes
Do you agree with our Terms & Conditions?*
Terms & Conditions can be found here: Click to see Terms & Conditions
- Yes

Subtotal
Extras (t-shirts and/or raffle tickets)
Total

Swim Group Member Sign Up quantity

SKU: swim-group Category: Lyme Splash Purchase

Description

Description

Please register and pay for your group via the Lyme Splash Team and then each group member needs to fill in this registration form.

Information Sheets & Forms for Swimmers

Can be found on the Downloads page

Related products

Water Polo – BBQ
£17 Adult, £9 Child Select options
Raffle Tickets
£1.00 – £20.00 Select options
Water Polo Team Registration (Men’s)
£110.00 Select options
Swim Registration
£45.00 Select options

Annual Events

Lyme Splash Water Polo Championship

Lyme Regis to Charmouth Challenge Sea Swim

Copyright © 2018 Lyme Splash

Join Waitlist We will inform you when the product arrives in stock. Please leave your valid email address below.