BRITISH LONG DISTANCE
SWIMMING ASSOCIATION
CHAMPIONSHIP ENTRY FORM
CHAMPIONSHIP
Torbay (Senior/Veteran)
DISTANCE
8 Miles (Seniors) (please note there will be a time limit of 6½ hours)
4 Miles (Veterans) (please note there will be a time limit of 3 hours)
DAY / DATE
Saturday 4th July 2015
ENTRY FEE
if you supply your own craft and competent crew £70.00 for full course or
£55.00 for one way Vet. If craft and crew required add £50.00
All entrants must be fully paid up members of the BLDSA
CLOSING DATE
SENIOR
8 MILES
17th May 2015
Please use BLOCK LETTERS. All sections MUST be fully completed.
ENTRANT: Please enter me for the above Championship in the following event.
VETERAN
F/STYLE
BRST/S
4 MILES
SURNAME:
FORENAME:
AGE:
LADIES
DATE OF BIRTH:
GENTS
/
/
ADDRESS:
POSTCODE:
TELEPHONE NUMBER: Home
Mobile
e.mail
BLDSA MEMBERSHIP NUMBER:
CLUB / TOWN
(For programme and results)
LONG DISTANCE SWIMMING EXPERIENCE:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Average time to swim a mile over a six mile course?
E.g. Bala or similar
International Swimmers
PLEASE NOTE: CIVIL LIABILITY INDEMNITY AND PERSONAL ACCIDENT COVER IS ONLY PROVIDED TO THOSE MEMBERS
OF THE BLDSA WHO ARE UK RESIDENTS.
INTERNATIONAL COMPETITORS MUST ATTACH A COPY OF A 2015 MEMBERSHIP CARD FROM YOUR COUNTRY’S
GOVERNING BODY OR EVIDENCE OF ALTERNATIVE PERSONAL INSURANCE WHICH COVERS PARTICIPATION IN OPEN
WATER SWIMMING EVENTS.
CERTIFICATE OF SWIMMING ABILITY
I certify that in my opinion and having regard to the nature of this Championship, the entrant is a competent swimmer. (B.L.D.S.A. Official or
Club Coach)
SIGNED:
Date
Page 1 of 4
SEA KAYAK DETAILS
(Please read carefully section F of the Championship Rules, particularly regarding limitation of entries)
Have you arranged to bring your own Sea Kayak & crew?
IF YES. Please give name
Yes
No
Address & Tel No
BUC three star or equivalent
Yes!
! No!
!
of Kayaker
If you are not bringing your own kayak and crew an additional £50.00 is required and your entry we accepted
subject to the availability of kayakers on the day of the event
MEDICAL DECLARATION
"In the event of an emergency, is there any information which rescue personnel, first aiders or ambulance crews/hospital may need to know in order
to assist you? Please include details of any medical conditions (including specific instructions for treatment in an emergency, if
applicable), disabilities (e.g. mobility restrictions, visual impairments, deafness, learning difficulties, and any subsequent special requirements), or
any other information which could be relevant in the event of an emergency. This information will be held in confidence and distributed only to
rescue and safety officials"
Do you have any medical problems we should be aware of? YES ! NO !
If yes please list these here: _____________________________________________________________________________________
______________________________________________________________________________________
Should you require medical assistance at this event is there any special medication or treatment you require? If so please list this here:
_____________________________________________________________________________________
I declare that if I enter the swim whilst pregnant, I will inform the swim secretary at the earliest possible opportunity, and will provide him/her
with a letter from a doctor or midwife confirming my suitability to enter the event. I understand that entry may be refused to pregnant swimmers
at the discretion of the swim secretary, following a risk assessment"
Signed________________________________________________
___________________________________________________________________________________________________________
IT IS YOUR RESPONSIBILITY TO MAKE SURE YOU HAVE YOUR MEDICATION
DECLARATION
I am an eligible competitor in accordance with the B.L.D.S.A. Championship Rules.
I have read, understand and will abide by the B.L.D.S.A. Championship Rules.
I am a fully paid up member, a Day / Temporary or life member of the B.L.D.S.A.
The particulars given on this entry form are true.
I am not suffering from any illness or disability known to me which would render my participation in this Championship inadvisable.
(A MEDICAL EXAMINATION MAY BE REQUIRED)
“I acknowledge that I am aware of all the risks inherent in open water swimming. I hereby waive any and all rights to claims for loss
or damages, arising out of my participation in this event, against the B.L.D.S.A. or any individuals officiating or supervising this
B.L.D.S.A. event.”
I acknowledge that the B.L.D.S.A. relies entirely on the contents of this Entry Form in accepting my request for inclusion in these
Championships.
SIGNATURE OF ENTRANT:
DATE:
SIGNATURE OF PARENT:
DATE:
(If entrant is under 18 years of age)
PLEASE RETURN THIS FORM (WITH FEE) TO:
SWIM SECRETARY Peter Larrad, 19 Russell Avenue, Swanage, Dorset, BH19 2ED
email: [email protected]
Cheques, Postal Orders etc are to be made payable to “B.L.D.S.A.”
Please enclose a stamped addressed envelope with the entry form
Page 2 of 4
BLDSA TORBAY SWIM 4th JULY 2015
INFORMATION
1. ENTRIES WILL BE ACCEPTED BY POST TO THE SWIM SECRETARY.
2. CLOSING DATE IS 17TH May 2015. NO ENTRIES WILL BE ACCEPTED AFTER THIS DATE.
3. IF YOU SUPPLY YOUR OWN CRAFT AND COMPITANT CREW £70.00 FOR FULL COURSE OR £55.00 FOR ONE
WAY VET. IF CRAFT AND CREW REQUIRED ADD £50.00
4. NUMBER OF SWIMMERS WILL BE LIMITED TO A MAXIMUM OF 30. PRIORITY WILL BE GIVEN TO
SWIMMERS PROVIDING THEIR OWN ESCORTS AND THOSE ENTERING THE FULL COURSE.
THEREAFTER PLACES WILL BE ALLOCATED ON A "FIRST COME FIRST SERVED BASIS”
NOTE
THE TORBAY AUTHORITIES WILL NOT PERMIT THE SWIM TO TAKE PLACE UNLESS EVERY SWIMMER HAS A
COMPETENT ESCORT. WHILST EVERY STEP IS BEING TAKEN TO ENSURE SUFFICIENT KAYAKERS,
SWIMMERS MUST BE AWARE THAT IF, ON THE DAY, THERE ARE TOO FEW CANOEISTS THEN SOME
SWIMMERS MAY NOT BE ABLE TO TAKE PART.
THIS IS NOT NEGOTIABLE!
Costumes
No costume must extend outside the highlighted are detailed in the picture below
THE SWIM
1.
SWIM WILL START AT MEADFOOT BEACH AT 11.00AM.
2.
THERE WILL BE A TIME LIMIT OF 6HOURS 30 MINUTES.
3.
THE VETERANS CHAMPIONSHIP WILL BE 1 WAY TO FISHCOMBE BEACH WITH A TIME LIMIT OF 3 HOURS.
VETERANS WISHING TO CONTINUE AND RETURN TO MEADFOOT MUST INDICATE SO ON THEIR ENTRY
FORM.
4.
ALL SWIMMERS MUST PROVIDE A "FLAG ALPHA" AND WHISTLE FOR THEIR CANOEIST. THIS IS THE
SWIMMERS RESPONSIBILITY. IF YOU DO NOT HAVE THESE THEN YOU WILL NOT SWIM.
5.
BREASTSTROKE SWIMMERS MUST WEAR A PINK SWIMMING HAT. FREESTYLE SWIMMERS ANY OTHER
COLOUR BUT PREFERABLY LIGHT COLOURED FOR EASE OF VISIBILITY.
6.
THE SWIM IS RUN UNDER BLDSA RULES SO ONLY TRADITIONAL SWIMMING TRUNKS/COSTUMES (NO
"LEGS" OF ANY SORT) MAY BE WORN
7.
THE RACE REFEREE MAY, IF HE/SHE THINKS FIT, ORDER FROM THE WATER ANY SWIMMER WHO DOES
NOT COMPLY WITH INSTRUCTIONS GIVEN AT THE BRIEFING MEETING, OR WHOSE CONDITION HE/SHE
DEEMS TO BE NOT SATISFACTORY.
SWIMMERS
1. ALL SWIMMERS AND KAYAKERS MUST REGISTER ON ARRIVAL AT MEADFOOT BEACH. REGISTRATION
WILL TAKE PLACE ON THE VERANDA ABOVE THE CAFE FROM 8.0AM UNTIL 9:30AM PLEASE DO NOT
LEAVE IT TO THE LAST MINUTE.
2. SWIMMERS BRINGING THEIR OWN CANOE /CANOEIST MUST CONFIRM THIS AT REGISTRATION.
Page 3 of 4
3. YOUR LEFT ARM WILL BE MARKED WITH YOUR SWIM NUMBER AT REGISTRATION.
4. YOU WILL BE GIVEN A BLACK BAG AND LABEL FOR TOWEL/CLOTHING WHICH CAN BE TAKEN TO
FISHCOMBE (FOR VETERANS) OR GIVEN TO YOUR CANOEIST.
5. THERE WILL BE A BRIEFING MEETING FOR OFFICIALS, SWIMMERS AND CANOEISTS AT 9.45AM ON THE
BEACH. AT THIS TIME SWIMMERS WILL BE ALLOCATED A SPECIFIC CANOEIST.
6. SHOULD AN ALTERNATIVE COURSE HAVE TO BE USED THEN SWIMMERS WILL BE INFORMED AT THE
START OF THE BRIEFING
7. SWIMMERS ARE ADVISED TO BRING FOOTWEAR TO USE WHEN GETTING IN AND OUT OF THE WATER.
MEADFOOT IS A PEBBLE BEACH THEREFORE NOT EASY TO SEE SHARP OBJECTS.
CANOEISTS
1.
ALL CANOEISTS MUST REGISTER WITH THE SWIM SECRETARY BY NO LATER THAN 9.30AM- PLEASE
DO NOT LEAVE IT UNTIL THE LAST MINUTE, GIVING NAME AND CONTACT TELEPHONE NUMBER.
2.
CANOEISTS MUST ATTEND THE SWIM BRIEFING MEETING AT 9.45AM.
PRESENTATION
PRESENTATION OF TROPHIES AND CERTIFICATES WILL TAKE PLACE ON THE "VERANDA" AT MEADFOOT
BEACH AT APPROXIMATELY 6.00PM
SWIM SECRETARY
Peter Larrad, 19 Russell Avenue, Swanage, Dorset, BH19 2ED
Tel No.: 01929 426948
07940 895026
email: [email protected]
Page 4 of 4