North District Open Water 2025
Sign in to Google to save your progress. Learn more
Entry Form
Please populate form below for entry to North District Open Water Championships 2025
First Name *
Surname *
Registration No. *
Please enter "Temp" if a temporary membership is being applied for.
Email Address *
Telephone No. *
Address *
Post Code *
Category *
Date of Birth *
MM
/
DD
/
YYYY
Club *
Please enter "Temp" if a temporary membership is being applied for.
Medical Questionnaire *
Please select any that apply.
Required
Medical Details
If you have selected any of the medical conditions above, please provide details.
Medications
Please list any/all medications that you currently take.
Disability Classification (if relevant)
If applicable, please provide information regarding your formal classification.
Emergency Contact Details *
Please provide name of emergency contact
Relationship to athlete
 *
Contact number of emergency contact
 *
Event Entries *
Please select all events you wish to enter.
Competitors must be 10 years or over on the day of the event.
Required
Payment *
All payments should be made to SASA North District by bank transfer.

Account Number: 00882011
Sort Code: 80-05-16

Reference should be, "OW25-surname of entrant".

Please provide payment made on date below.
MM
/
DD
/
YYYY
Athletes Declaration *
  1. I will abide by the S.A.S.A. Open Water Swimming Regulations.
  2. I am a registered competitor with the S.A.S.A., A.S.A., W.A.S.A. or other National Association or have submitted a temporary membership application form.
  3. I am not knowingly suffering from any disability or illness, which would render my participation in this championship inadvisable.
  4. I acknowledged that participation in this event is at my own risk and waive and release any and all claims for damages which I may have against S.A.S.A. North District for any injuries or illness and any lose of property resulting from my participation.
  5. Given the nature of the event, I am a sufficiently competent swimmer.
  6. I understand that in the event of my retirement during the race, safety crews will use all means necessary to assist me into the safety craft.
  7. If I am age 16 or under, I have parental / guardian consent to participate in the event.
  8. The information I have given on this entry form is correct.
  9. I understand that entry fees are not refundable.
  10. I acknowledge that this is a public event and upon entering, this may result in the recording and publication of my image. Images may be used on social media, websites and printed marketing materials and may also be shared with press and media.
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms