2023 Lessons - Wild Swim Scotland Consent and Safety Agreement Form

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Required for all 2023 participants

Email *

Wild Swim Scotland

Surname

First Name

Mobile Tel No.

Communications will be made via email, monthly newsletters to your email in box and occasionally via text message or Whats App. I use Instagram to share a few selected photos and this is linked to my Facebook account. If you would like tagged please add your Instgram ID below and I will try to make sure you are included.

Emergency Contact

Emergency Contact Tel No.

Address

I will be swimming in;

Swimsuit Only (rash top / leggings)

Swimsuit with Neoprene Vest / Jacket

Wetsuit

Clear selection

If this is your first Open Water Swimming Session you should have agreed to an Introductory Session with Maree or Elaine. Please check box 1. If you have been swimming please complete boxes 2 - 7 to give further information.

This is my first Open Water Swim session and I have arranged a 1:1 Winter Check In Session with Wild Swim Scotland

I have been a regular Open Water Swimmer / Dipper in the last 6 months

I have been Open Water Swimming during the Winter of 2022/23

I consider myself acclimatised to the Cold Water, which will be below 12 degrees for much of the period

I understand there are dangers associated with cold water swimming and have read through the Risks and Benefits leaflet provided.

I am aware of my body and will alert staff should I start to display my personal warning signs, which will indicate I should exit the water.

Swimming Ability, please check all that apply

I can swim at least 200m continuously

I can only swim Breaststroke

I would prefer to swim Breaststroke in the Open Water

I would like to learn to swim Front Crawl in the Open Water

I enjoy swimming front crawl in the swimming pool and would like to develop my Front Crawl in the Open Water

I can swim more than 300m Front Crawl in the Open Water and would like to develop my adaptability and techniques in the Open Water

I have an event or distance in mind and would like to train towards it, please give details below

Other:

Any other relevant information for swimming experience

Health and Fitness Information

I consider myself fit and healthy and able to participate fully in this activity

I have a pre-existing health condition, I will outline details below and highlight to coach prior to session

I may require some adaptation to the activity and will discuss this with the coach prior to the session

Any relevant medical information as indicated above.

GDPR Consent

I agree to my data being held by Wild Swim Scotland, for the purposes of contact, medical and emergency purposes, in-line with the GDPR policy outlined on www.wildswimscotland.co.uk

Photo Consent

I agree to my photograph being taken during swim sessions and used on Wild Swim Scotland’s website and Social media platforms. If requested Wild Swim Scotland will remove any images from these platforms.

I agree to Wild Swim Scotland’s Terms and Conditions as outlined on www.wildswimscotland.co.uk

Option 1

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