The SHACs Open Water Swimming - Membership Application.
In order to swim at The SHACs Open Water Swimming Sessions this Form must be completed. You may also be asked to complete a open water competency/swimming ability review at your first session at the discretion of the management team.
Email address *
Full Name
Your answer
Age
Your answer
Address
Your answer
Contact Telephone Number
Your answer
Swimming Ability - Please tick as applicable *
Required
Confidence , Please rate the following two questions on a scale of 1-10 and provide comments. 1=Strongly agree, 4=Agree, 7=disagree, 10=strongly disagree. Question 1: I have a basic fear of water and feel nervous when swimming, please detail reasons if known.
Your answer
Question 2: I have never swam in open water before
Your answer
Health. I have pre existing health problems or injuries that may effect my ability ti participate safely and successfully in an open water swimming course. *
If you answered yes to the above question please provide details in full below
Your answer
Have you ever been on an open water swimming course before?
If yes to the above question what was the course you attended?
Your answer
I would like to attend an introduction open water swimming course with The SHAC.
I would like to attend an open water swimming Masters Course with The SHAC
What open water swimming experience do you have if any? Events, Swims etc please list below
Your answer
Emergency contact details: Full Name, Relationship, Contact Number *
Your answer
Personal Goals from open water swimming:
Your answer
I own my own wet-suit *
Please confirm you are happy to hear from us regarding events, equipment and other activities. *
Disclaimer: The Surrey Hills Adventure Company accepts no responsibility whatsoever for any injury or illness sustained or suffered by any person or persons so engaging in any activities offered by ourselves. We also accept no responsibility for any loss or damage to personal belongings however caused, whether due to negligence of ourselves or arising from the use of activities made available. I further understand that any swim sessions can be cancelled, sometimes at short notice in order to maintain the safety of all swimmers and at the Discretion of The SHACs Management team. *
Required
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms