OPEN WATER SAFETY FORM

PERSONAL DETAILS

First Name:	Last Name:
Home Phone:	Mobile:
Email:
Current Sporting Club/s:

EMERGENCY CONTACT

First Name:	Last Name:
Phone:

HEALTH

Do you have any medical history, allergies or medication that we should be aware of? If yes, please provide details:

PANIC OR ANXIETY ATTACK IN THE OPEN WATER

Have you ever experienced a panic or anxiety attack when taking part in open water swimming events or while you are training?

SWIMMING COMPETENCY

The relevant competency tests (entry requirements) must be successfully completed (in the pool or in the ocean) before taking part in the Western Aquatic Academy Ocean Clinics. Which of the following competency test/s have you completed? (Please tick):

TERMS & CONDITIONS

1. I acknowledge that ocean swimming involves the real risk of serious injury or even death from various causes including overexertion, equipment failure, dehydration and/or accidents with other entrants.

2. I understand that I should not take part in this training session if the conditions are not suited to my open water swimming ability as it may pose a risk to both my own safety and the safety of the instructors.

3. I will communicate to the instructor/board paddler if I am uncomfortable or distressed throughout the training session.

4. By completing this form I accept all risks involved from my participation in this training session which could result in loss of life or permanent injury. Accordingly, I release all persons or corporations associated directly or indirectly with the conduct of the event from all claims demands and proceedings arising out of my participation and I hereby indemnify them against all liability (including liability for their negligence and the negligence of others) for all injury, loss or damage arising out of or connected with my participation in this training session. This release shall extend to and include Western Aquatic Academy Ocean Clinic respective directors, partners, managers, officers, agents, contractors, employees and volunteers including medical and paramedical personnel appointed for the event, the owners, licensees and occupiers of land upon which the event or any part of it is conducted, any statutory body or local authority having control over any land upon which the event or any part of it is conducted or which is involved directly or indirectly with the event in any manner whatsoever and promoters, sponsors and event organisers. This release and indemnity continues forever and binds my heirs, executors, personal representative and assigns.

5. I consent to receiving any medical treatment that the instructor thinks is necessary during or after the training session.

6. Safety precautions undertaken by the instructor are a service to me but are not a guarantee of safety.

7. I am fully responsible for the security of my personal possessions at the training session.

8. I agree to my name and contact details being included on the Western Aquatic Academy Ocean Clinic email database.

9. I agree to any images arising from my participation in the Western Aquatic Academy Ocean Clinics being used on the Western Aquatic Academy website, Facebook Page and/or promotional material.

Name:
Signature:	Date: