COLD WATER SWIMMING DISCLAIMER

Please select the RVIVAL Experience are you joining?

First name

Last name

Experience start date

Phone

Postcode

Name of Emergency Contact

Emergency Contact Telephone Number

If YES please give details.

Do you ever feel pain in your chest when you do activity or are in cold conditions?

YES

Do you have any health concerns, e.g Asthma that may be made worse by exercise or cold water? If yes please give details below.

Do you ever faint or have spells of dizziness?

YES

SPECIFIC FOR COLD WATER SWIMMING ACTIVITIES:

It is important to consult with a healthcare professional before participating in cold water immersion, especially if you have any pre-existing health conditions or are taking any medications. If you answer Yes to ANY of the above questions we advise you to seek advice from a doctor before attending event. Cold exposure can lead to increased stress on the body, ensure you are adequately hydrated and fuelled before and after this activity. We wish to highlight that cold water swimming under 15°c can be a potentially hazardous physical activity and any swimming can lead to risk of injury and even death in exceptional circumstances.

Swim ability (Please tick all that are applicable to you)

I cannot swim

I can swim 100 metres Breaststroke in a pool

I can swim 100 metres Front crawl in a pool

I have never been in open water

Please give details about your open water swimming experience?

Is there anything in particular that you would like to achieve or learn from your swimming session(s)?

Will you be wearing a wetsuit>

YES

It is important to take your health and safety whilst swimming seriously. We wish to highlight that open water swimming and cold water under 15°c can be a potentially hazardous physical activity and any swimming can lead to risk of injury and even death in exceptional circumstances.

Participants should be aware of and accept these risks and be responsible for their own actions and involvement whilst participating. Precautions to minimise this risk will be taken throughout the session.

This session is run by and supervised by an appropriately qualified and experienced instructor (or instructors) in accordance with national governing body/common practice.

In recognition of the potential dangers and risk of open water swimming, I confirm that (Please tick)

I consent to photographs and/or videos being taken during the experience and authorize their use by RVIVAL for promotional, marketing, and media purposes, including but not limited to social media, website, and print materials.

By registering for this experience, I certify that all information provided is accurate and complete, and that I agree to the terms and conditions stated above.

I acknowledge that open water and cold water dipping involves inherent risks, including the potential for personal injury, death, and loss or damage of property.

I confirm that I have read and understand these risks, and I agree to assume all responsibility for my participation in the workshop.

I hereby waive and release any and all claims, actions, or liabilities against RVIVAL its directors, officers, employees, agents, volunteers, contractors, and any other associated parties (collectively, the "Released Parties") for any injuries, damages, or losses that I may sustain while participating in cold open water swimming and the activities outlined in the experiences I am participating in.

Acknowledgment and Consent

By signing below and submitting this form, I confirm that I have read, understood, and agree to participate in the activities associated with my RVIVAL experience. I acknowledge the safety measures and risks assosiated with this experience and choose to participate in the experience as detailed in my itinerary provided by RVIVAL. I hereby give my consent to participate, fully aware of and in agreement with the conditions and precautions outlined.

Signature

COLD WATER SWIMMING DISCLAIMER

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