Name: Swim Registration
SKU: swim-register
Price: 30.00 GBP
Availability: InStock

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 medal for completion of the swim & a chance to win one of eight delicious prizes from Dorset Chocolatiers Chococo.

Add a Lyme Splash T-Shirt (£12 each)

T-shirts will be posted a few days after the event, price includes P&P

Add Raffle Tickets (£1 each)

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

Have you swum in open water in 2018/2019?*

Yes
No

Have you swum one mile or more 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 have 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 2017.
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)*

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

Shop

Swim Registration

Instructions

Part A: Pre-Entry Review/Assessment

Part B: Pre-Challenge Fitness Review

Part C: Personal Information To Register

Address

Description

Information Sheets & Forms for Swimmers

You may also like…

Raffle Tickets

Swim Registration

Instructions

Part A: Pre-Entry Review/Assessment

Part B: Pre-Challenge Fitness Review

Part C: Personal Information To Register

Address

Description

Information Sheets & Forms for Swimmers

You may also like…

Raffle Tickets

Related products

Water Polo Team Member Sign Up

Lyme Splash T-Shirt – Sea Swim

Water Polo – BBQ

Water Polo Team Registration