Questions that you will need to complete when you purchase a swim place at checkout.

• * asterisks indicate a compulsory question 

1. Swimmers First name | Swimmer Last name *

2. Swimmers Email *  (Each Swimmer entering the swim, will require a unique email address.) 

3. Swimmer Mobile Phone Number *

4. Swimmer Address *

5. Swimmers Date of birth (dd/mm/yyyy) *

6. Your Age on the day of the swim? *

7. Are you associated with one of our Partners? * 

8. Name of your swim club/group/organisation? (please enter n/a if not applicable) *

9. Which Category would you like to enter? (Female or Male) *

10. Which Division would you like to enter?  (Non wetsuit / Wetsuit)*

11. Estimated time to complete your swim in mins (Full=Max 180 mins) *

12. Do you want to be included in any plans for the Fallback Date of 7th July*

13. Do you have any Medical Ailments that we as Event Organisers should be aware of *

14. Please provide details of any medical ailments that we should be aware of. If none - State none *

15. Emergency Contact Name (someone who is not taking part in the event) *

16. Emergency Contact Mobile Number *

17. Please confirm that your Emergency Contact is not taking part in the swim*

18. Will you be using the swim to raise money for a charity of your choice? * 

19. Please name the charity of your choice (enter N/A if you are not using the event to raise sponsorship) *

20. I want to add Gift Aid to my donation

21. I confirm I meet the age for entry (Minimum age for entry is 18 on day of swim) *

22. I confirm I have read and understood the disclaimers *

23. I agree to and will abide by the event rules *

24. I hereby accept the full Conditions of Entry: *

25. Name of person submitting this entry *

26. Mobile number of person completing entry if different to swimmer