Swimmer Responsibility Statement 2021 – 22

Please read and download a copy of the Swimmers Responsibility Statement. The form below confirming that you have done so must be digitally signed and submitted to Lenches Lakes before your first swim. You only need to complete the form once.

if you would like to download a copy please click here

This form must be completed before your first swim
  • Participants are required to be able to swim a minimum of 50 m ,be comfortable in deep water and be able to tread water .
  • Do you have any cardiovascular conditions e g. high blood pressure, dizziness or palpitations?
  • Is there a history of cardio—vascular conditions in your immediate family
  • Do you have any respiratory conditions e.g. asthma?
  • Do you have a neurological condition e.g. epilepsy?
  • Are you pregnant?
  • If you have answered Yes to any of the above questions it would be sensible to check with your GP /Consultant that you are fit to swim in cold water before participating.
  • Do you have any allergies, mobility issues or impaired sight or hearing that may require additional support? If so please provide details below
  • In the event of an emergency is there any medical information that the medical services should be made aware of? If so please provide details below
  • Please enter your name here. By entering your name here you acknowledge that this is the equivalent to your signature
  • This field is for validation purposes and should be left unchanged.