JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Application for a MOWSA-Sanctioned Swim
Please complete this form to register your interest in completing a MOWSA-observed solo swim in Massachusetts. We will get back to you within 10 business days to discuss your plan and scheduling. More information about solo swims is available here:
https://www.massowsa.org/solo-swims
Sign in to Google
to save your progress.
Learn more
Name
Your answer
Email
Your answer
Phone
Your answer
Home address
Your answer
Age
Your answer
Have you been cleared by a medical practitioner to attempt this swim? (We may request a signed statement from your health care provider prior to the start of the swim attesting to your fitness to attempt the planned swim.)
Yes
No
Clear selection
Emergency contact name & relationship
Your answer
Emergency contact phone number
Your answer
Category for swim classification
Male
Female
Open
Tandem (two swimmers of any gender swimming together with a single support boat)
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of MOWSA.
Report Abuse
Forms
