Swimming Victoria Open Water Relay Entry Form

Swimming Victoria Open Water Relay Entry Form

2026/27 Victorian Open Water Swim - 19 December (20 December as back-up date)
This form is the official Entry Form for the 4x150m Relay Event at the 2026/27 Victorian Open Water Swim held at Eastern Beach, Geelong on the 19th December (20th December as the back-up date).

There will be a maximum of 20 relay teams entered into this event.

This is a mixed event, meaning there are to be 2x males, and 2x females entered in a team. Relay team members need to swim in the order listed on the team sheet, if found swum in the wrong order, the team will be disqualified.

Entry fee is $40 per relay team.

Any questions, please direct them to events@vic.swimming.org.au
Name of Person Completing this Form
Team Name
Phone Number - should we need to contact for clarification
Please enter a valid phone number.Format: (000) 000-0000.
Email for confirmation
example@example.com

Swimmer Details

Please note: the order the swimmers are displayed, the order they will be entered into the team
- Full Name
- Date of Birth
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit year19/12/2014
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Address
  example@example.com
- Emergency Contact Full Name
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Do you have any medical history that the event organiser should know about?
  i.e. allergies, asthma, past surgeries, regular medication etc
- Full Name
- Date of Birth
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit year19/12/2014
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Address
  example@example.com
- Emergency Contact Full Name
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Do you have any medical history that the event organiser should know of?
  i.e. allergies, asthma, past allergies, regular medication etc
- Full Name
- Date of Birth
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit year19/12/2014
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Address
  example@example.com
- Emergency Contact Full Name
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Do you have any medical history that the event organiser should know about?
  i.e. allergies, asthma, past surgeries, regular medication etc
- Full Name
- Date of Birth
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit year19/12/2014
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Address
  example@example.com
- Emergency Contact Full Name
- Emergency Contact Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Do you have any medical history that the event orgniser should know about?
  i.e. allergies, asthma, past surgeries, regular medication etc.

Victorian Open Water Swim Waiver
Participant acknowledgement of risk & event cancelation

In consideration of acceptance of my entry in The Victorian Open Water Swim, I agree that:

1. I am aware of the risks of participating in this Open Water Swimming event. I also agree to abide by the officials if they deem it safer that I am removed from the water.

2. I know of no medical reason why I should not participate in The Victorian Open Water Swim. I acknowledge that The Victorian Open Water Swim is a strenuous and hazardous activity and I affirm that I have properly trained for and fully satisfied myself as to my physical and medical condition to compete in the Event and I consent to receive such medical aid or preventative treatment which may be deemed advisable in the unfettered discretion of Victorian Open Water Swim Medical Officials and Lifesavers in the event of any injury or accident or illness to me as the result of my participation in the Event

3. I agree to, abide by and accept the rules and regulations of The Victorian Open Water Swim and to accept the decisions of the Victorian Open Water Swim organisation.

4. I consent to the free use of my name and photograph in any newspaper promotional advertising material, video or telecast by the Event Organiser and/or its sponsors.

5. I acknowledge that:

(a) The Victorian Open Water Swim is a recreational activity which involves a risk of physical harm.

(b) My personal property may be lost, damaged or destroyed in the course of my participation in the Victorian Open Water Swim.

(c) The Victorian Open Water Swim relies on the information provided by me and I state that all such information is accurate and complete.

(d) That I have been warned of the risks of participating in Victorian Open Water Swim.

(e) Notwithstanding the risks of physical harm, loss and injury inherent in participation in Victorian Open Water Swim, I agree to participate at my own risk.

6. I agree to release and hold harmless The Victorian Open Water Swim Organisers, its servants, employees and agents from and against any liability arising out of any injury, loss, damage or death caused to me or my property or any other person arising from or in connection with my participation in The Victorian Open Water Swim whether such injury, loss, damage or death was caused directly or indirectly by negligence, breach of contract or any way whatsoever other than where the injury, loss, damage or death was caused solely by the negligence of The Victorian Open Water Swim Organisation, its servants, employees or agents.

7. I agree to indemnify and hold harmless The Victorian Open Water Swim Organisers, its servants, employees and agents from all claims, damages, losses, injuries and expenses arising out of or resulting from my participation in the Event.

8. I accept that I must be available to swim on both the nominated date and the day after, should the swim event need to be rescheduled.

9. I also acknowledge that I will not be eligible for a refund if I do not make myself available for both days.
By submitting this Online Relay Entry Form, you are agreeing that all entered swimmers have read and understood the contents of the 2026 Victorian Open Water Swim Waiver
Signature - By signing below I assert that I have read, understood and agree to all of the documents I have selected above.

Payment
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2026 Victorian Open Water Swim - 4x150m Relay Entry
$40.00 AUD

Total

$0.00 AUD
Should be Empty:

Swimming Victoria Open Water Relay Entry Form

Swimmer Details

Victorian Open Water Swim Waiver

Payment