Swimmer Certificate of Competency
Swimmer Certificate of Competency As part of the safety and management requirements for swimmers entering The Sydney Morning Herald Cole Classic Dee Why to Manly swim, all swimmers who wish to enter the event must complete the following swimmer safety certificate and submit it to the event management committee at [email protected] by 5pm Monday January 26, 2015. Without completing this certificate, swimmers will not be permitted to enter into this event. Swimmers Name:
Contact number:
Swimmers DOB: __/__/____ Do you have any medical conditions that will affect your ability to complete this swim?
YES/NO
If yes, please specify: Have you ever been advised to get a medical clearance due to a medical condition you have?
YES/NO
If yes, please specify: Background: please list any long distance swim events you have completed in the past. Name of Swim
Organised by
Time
Distance
Date
Alternatively, if you have never completed an organised or sanctioned long distance swim, please have your coach complete the section below. Each swimmer who has not completed an official ocean swim, and listed their results above, is required to complete a 10km pool swim, timed and recorded by a registered swim coach before 5pm Monday January 26, 2015. Coach Name:
Swim Club:
Contact number:
Email:
Pool location:
Date of timed swim:
Time that the 10km swim was completed in: In signing this form, I declare that, I (coach) have accurately timed the above named swimmer, who has successfully completed a 10km pool swim and that all information recorded by myself is true and accurate. Coach Signature: Please return this form to: [email protected] Sighted and checked by (Office use ONLY):
*Fairfax Events reserves the right to refuse entry to the Event if it has a reasonable basis to believe that participation in the Event may lead to a serious risk to the individual’s health or safety.
(Office Use Only) Notes:
*Fairfax Events reserves the right to refuse entry to the Event if it has a reasonable basis to believe that participation in the Event may lead to a serious risk to the individual’s health or safety.
Contact number:
Swimmers DOB: __/__/____ Do you have any medical conditions that will affect your ability to complete this swim?
YES/NO
If yes, please specify: Have you ever been advised to get a medical clearance due to a medical condition you have?
YES/NO
If yes, please specify: Background: please list any long distance swim events you have completed in the past. Name of Swim
Organised by
Time
Distance
Date
Alternatively, if you have never completed an organised or sanctioned long distance swim, please have your coach complete the section below. Each swimmer who has not completed an official ocean swim, and listed their results above, is required to complete a 10km pool swim, timed and recorded by a registered swim coach before 5pm Monday January 26, 2015. Coach Name:
Swim Club:
Contact number:
Email:
Pool location:
Date of timed swim:
Time that the 10km swim was completed in: In signing this form, I declare that, I (coach) have accurately timed the above named swimmer, who has successfully completed a 10km pool swim and that all information recorded by myself is true and accurate. Coach Signature: Please return this form to: [email protected] Sighted and checked by (Office use ONLY):
*Fairfax Events reserves the right to refuse entry to the Event if it has a reasonable basis to believe that participation in the Event may lead to a serious risk to the individual’s health or safety.
(Office Use Only) Notes:
*Fairfax Events reserves the right to refuse entry to the Event if it has a reasonable basis to believe that participation in the Event may lead to a serious risk to the individual’s health or safety.
