Membership Form

Name

This field is for validation purposes and should be left unchanged.

About You

Full Name*

Email*

Address & Postcode

Phone*

Gender*

Date of Birth*

Minimum age of 11 ½ years old as at 1 May

This Booking Is For Somone Under 16 Years Old

Yes

If under 16yrs, name of accompanying guardian.

Name

Phone

Your Emergency Contact Details

Please provide contact details for someone we can reach in case of an emergency.

Full Name*

Their Phone Number*

Relationship to you*

Dover Harbour is a NON-Lifeguarded Beach, with limited entry and exit points to and from the designated ‘swim zone’ (see attached map). A full lap of the harbour is over 1.5km and the shorter circuit is 800m, therefore individuals must be able to swim this distance unaided.

Your Swimming Ability

Please tell us about your Open Water experiences.

What is your longest swim and in what temperature? List any events or channels you have completed. Time (hr/min) and Temperature.

Approx no.of swim seasons:

Summer

Winter

Swim Times: Please tell us what you can about your swim speed.

Open Water / Pool 400m time:

Open Water / Pool 1,500m time:

Open Water Pace in Kilometres per hour:

Please note; we will use your times to group you with other swimmers of a similar speed.

Your Training Targets

Type of Swimmer:

Relay Swimmer

Solo Swimmer

List any events or channels that you are planning to swim, including dates.

If a relay swim, please state how many people are in the team. Please include any requirements for self- assessment / qualification swims.

Declaration

I declare the information I have provided about my SWIMMING ABILITY is accurate.

I agree to wear the coloured SWIM HAT provided by Neptune Channel Swimming.

I agree to apply my own GREASE / SUNSCREEN and for the areas of my body that I cannot reach (i.e. my back), I will select someone of my own free will who is willing to oblige.

For my own SAFETY, I agree to:

Take caution when swimming near moving boats,
Never dive or jump into the water,
Never swim whilst under the influence of alcohol or non-prescribed drugs,
Always swim within my physical & mental limitations.

I agree that if I am in the water for more than 2 hours, I will periodically FEED and take on fluids/nutrition as provided by Neptune Channel Swimming.

I agree to CHECK-IN at the ‘Waterside-Hub’ located on Swimmers Beach:

Upon entering the water when starting my swim,
Within the timeframe requested based on the water temperature / conditions on the day,
Upon exiting the water.

I understand that repeated failure/disregard to do so may result in the withdrawal of my membership and future participation within the group.

I declare the medical information I have provided is accurate as at today’s date and I agree to immediately inform Neptune Channel Swimming of any changes to my MEDICAL STATUS.

I understand that in the event of accident or injury during my participation, I give consent for Neptune Channel Swimming to:

Administer first aid,
Telephone my EMERGENCY CONTACT and/or the emergency services,
Share my medical status as required.

I understand that Neptune Channel Swimming takes individual or group PHOTOGRAPHS / VIDEO FOOTAGE for the purpose of keeping a training diary/blog and for marketing purposes. If I do not wish to be included, I will decline invitations to join team photos and/or bring the matter to the attention of a senior member of the beach crew.

I understand that Neptune Channel Swimming will retain my DATA for the purpose of administering the activity, and it will be kept in compliance with GDPR and the Data Protection Act 2018.

I understand that open water swimming is an extreme sport which may result in injury and possible death. I have been recommended to obtain my own INSURANCE COVER for participation in open water swimming and/or channel swimming (e.g. www.insure4sport.co.uk).

I understand that Neptune Channel Swimming is GOVERNED BY LAW in England and Wales and has a duty of care to maintain:

Risk assessments,
Normal operating procedures,
Emergency action plans,
Crew awareness and qualifications.

I understand the risks involved and, all being well, I agree to waive/release any claims for injuries, damages or losses that I may suffer or cause whilst participating.

I understand that Neptune Channel Swimming requires VOLUNTEERS to support participation and that for every hour I volunteer, I will receive 1 hour of FREE SWIM in return.

Signature

If under 16yrs, please ensure the parent/guardian signs.

Date

Membership Cost: £20 for the season

Daily Swim Costs:

Up to 2 hours – £5
Up to 4 hours – £10
Up to 6 hours – £15
Up to 8 hours – £20

About You

Your Emergency Contact Details

Your Swimming Ability

Your Training Targets

Your Medical Status

Declaration