Water Polo Team Bookings

Please pay for your Team and then each team member needs to fill in this registration form.

 

Water Polo Sign-up: Team Bookings

To take part in the 2017 Lyme Splash Water Polo Championship please fill in the form below for each entrant
  • bulletPART A: Pre-Entry Review/Assessment
  • Can you, swim, tread water and are happy out of your depth for over 6 minutes in the sea?
  • Are in a Water Polo team that plays currently or recently?
  • Team Name
  • bulletPART 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)?
  • Do you feel pain in your chest, shortness of breath or dizziness when you undertake physical activity?
  • In the past month, have you had chest pain when you are not doing physical activity?
  • Do you lose your balance because of dizziness or do you ever lose consciousness?
  • 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?
  • Are you pregnant?
  • We will do our best to accommodate any issues but in the interest of safety if we are unable to we will refund your entrance fee.
  • Do you suffer from epilepsy?
  • Do you suffer from diabetes mellitus and need to take insulin?
  • Do you know of any other reason that may affect your ability to take part in physical activity?
  • If yes, please state why:
  • If you have answered YES to any of the questions 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:
  • bulletPART C: PERSONAL INFORMATION TO REGISTER (All information must be provided - this information will not be shared with third parties):
  • 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:
  • Name and phone number to contact in an emergency
  • By signing up I have read and accept the event terms and conditions. Read Terms & Conditions here