IMPORTANT: please read this disclaimer carefully before signing. Any queries should be raised with the ASA Midland District Secretary

1. I am aware of the need to seek appropriate medical advice if I have any concerns as to the state of my health. I have not been informed by any medical practitioner and I do not have any knowledge of any medical condition which would make it inadvisable for me to participate in Open Water Swimming/Masters Swimming events or any other associated activities. Accordingly I hereby certify that I am physically fit and well to participate in any such training and events.

2. I am aware of and appreciate the inherent risks involved in such training and competition including the possibilities of injury and accident. I undertake always to conduct myself in a responsible and professional manner.

3. I undertake at all times to use my best endeavours to train and compete in a safe and proper manner and not to do anything which would expose myself or fellow swimmers to unnecessary risk of injury.

4. I further undertake at all times to take all reasonable safety measures for the protection of myself and fellow swimmers and to inform the referee of any concerns I may have as regards safety.

5. I acknowledge that during Open Water Swimming/Masters Swimming events the ASA Midland District cannot be held responsible for any loss or damage to personal belongings and that I must take all reasonable steps against any such loss or damage.

6. I hereby agree to abide by and be governed by the rules of the Amateur Swimming Association and all other laws and regulations applicable including the ASA Safety Laws and the Conditions of the ASA Midland District.

I have read and understand the above provisions and agree to abide by them

Signature of Competitor___________________________________ Date ___________________