Team Name *

Name Swimmer 1 *

Surname Swimmer 1 *

Email Swimmer 1 *

Gender Swimmer 1 *

Male

Female

Age on the day of the event Swimmer 1 *

ID Number Swimmer 1 *

Disability Swimmer 1 *

Yes

No

Medical Aid Name Swimmer 1 *

T-Shirt Selection Swimmer 1 *

Name Swimmer 2 *

Surname Swimmer 2 *

Email Swimmer 2 *

Gender Swimmer 2 *

Male

Female

Age on the day of the event Swimmer 2 *

ID Number Swimmer 2 *

Disability Swimmer 2 *

Yes

No

Medical Aid Name Swimmer 2 *

T-Shirt Selection Swimmer 2 *

Name Swimmer 3 *

Surname Swimmer 3 *

Email Swimmer 3 *

Gender Swimmer 3 *

Male

Female

Age on the day of the event Swimmer 3 *

ID Number Swimmer 3 *

Disability Swimmer 3 *

Yes

No

Medical Aid Name Swimmer 3 *

T-Shirt Selection Swimmer 3 *

Main Swimmer Contact Number *

Next of Kin (Name & Contact) *

Waiver and IndemnityBy ticking the checkbox below and submitting this registration, My team confirms that: We have read and understood this Waiver and Indemnity, We understand the risks involved, We voluntarily accept these risks and We agree to be bound by these terms.

Yes, I have read, understood and agree to the Participant Waiver, Indemnity and Assumption of Risk.