Australian Open Water Medical Declaration Form

Australian Open Water Medical Declaration

This form is ONLY REQUIRED if you have a pre-existing medical condition. Please do not continue with this form if you are perfectly healthy.
IF REQUIRED:

If you or your swimmer have any pre-existing medical conditions, please advise us via this form. The information will be sent to our Competition Manager and will be used by our Medical Team in the event of any unexpected medical episodes. This will allow them to treat you correctly should the need occur. The information will be kept confidential. After the event, all data within this form will be permanently deleted. SwimAus will not store this information in our systems or otherwise. If you have any questions or concerns regarding this declaration, please reach out to Shannon via shannon.smith@swimming.org.au
Name of Entrant*

First NameLast Name
Parent/Guardian Name (for swimmer under 18yrs)

First NameLast Name
Club*
E-mail*
Contact Number*

Type +61 for Australian numbersPhone Number
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Type +61 for Australian numbersPhone Number
List all pre-existing medical conditions, symptoms and medications here*
Terms and Conditions

If I am feeling unwell or unable to safely compete in open water swimming conditions due to the abovementioned pre-existing conditions, I will withdraw my entry into the Open Water Championships immediately.

I understand that should I withdraw during the race, I must seek medical clearance immediately after being removed from the water.

I agree that I will only partake in the race if I am feeling medically fit to do so on the day of competition.

I declare all the information in this form to be true.
Should be Empty:

Australian Open Water Medical Declaration

IF REQUIRED: