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Warriors Swimming Registration: *Boys/Girls/Ladies/Men
📍Millbrook School (beside the nursery)
     Mill End Rd
     High Wycombe 
     HP12 4BA


Wednesday's (term time only) 
Girls (15-) 7:30pm - 8:00pm 
Ladies (16+) 8:00pm - 8:30pm 

Sunday's (term time only) 
Boys (12-) 5:30pm - 6:00pm
Men (13+) 6:00pm - 6:30pm

Price: £5 per session block booking required
Term 1 Dates:
Wednesdays: 05/12/19 October 2022
Sundays: 9/16/23 October 2022

Term 2 Dates:
Wednesdays: 
2/9/16/23/30 November & 7/14 December 
Sundays: 
6/13/20/27 November 2022 & 4/11/18 December 

Important:
*arrive 10 minutes prior to your lesson to park and change (ideally arrive in your swim wear if possible) 
*payment is to be made in full at the start of term
*any sessions missed due to menses or illness are non refundable
*you give authorisation to be added to your chosen swimming WhatsApp group (boys, mens, ladies, girls). 
*whilst children are on site they remain the responsibility of their parent, please do not allow them to run in changing rooms
*no food to be brought into the venue
*shower time is limited to a quick rinse (2minutes) as there are very few showers we advise showering at home. 
*you must pick your hair out of the shower drainage 
*please be advised these sessions are not instructor led, we will have a female lifeguard for ladies & girls and a male lifeguard for men & boys. Please only sign up if you have previous swimming experience

Atia: 07543 015897

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PARTICIPANT'S DETAILS
First Name: *
Last Name: *
Telephone Number: *
Date of Birth: *
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Age: *
Email Address: *
Can you swim? *
Which session are you registering for? *
ICE (in case of emergency) DETAILS:
Emergency Contact's Name: *
Emergency Contact's Number: *
Relation: *
                                           MEDICAL QUESTIONNAIRE
Regular exercise is associated with many health benefits, yet any change of activity may increase the risk of injury.
Please complete questionnaire to help us avoid injury to you.
1.) Do you have any long term illness, health problem or disability that limits your daily activities? *
2.) In the past 4 weeks, on how many days have you done 30 minutes of sport and/or recreational physical activity? Do not count any curriculum activities at school/college. Do not include cycling or walking unless it was for sport or recreation. Gardening, DIY and housework should not be included. Please write in the number of days between 0-28: *
3.) Has a doctor ever stated you have a heart condition, for which physical activity needs clearance by a doctor? *
4.) When you do physical activity, do you feel pain in your chest? *
5.) Have you experienced chest pains in the last month, whilst not being engaged in physical activity? *
6.) Have you ever experienced a loss of consciousness or do you lose your balance because of dizziness? *
7.) Do you have a joint or bone problem that may be made worse by a change in your physical activity? *
8.) Is a doctor currently prescribing medication(s) for any long term conditions? If so, please provide details. *
Ethnicity: *
If you have answered “YES” to any of the above questions, please check with your doctor BEFORE you join sessions.
TERMS & CONDITIONS
Not all activities are suitable for everyone. If you ever feel any discomfort or pain, do not continue. You should understand that when participating in any activity or activity programme, there is the possibility of physical injury or even death. Warriors accepts no liability for injury, illness or health problems arising from your participation in any activity or activity programme you receive. You are voluntarily choosing to participate in an activity and you agree that any information, instruction or advice obtained from Warriors activity session will be used entirely at your own risk. You agree to disclose any physical limitations, disabilities, ailments or impairments to your health that may affect your ability to participate in any session and take part entirely at your own risk.

Warriors will not be responsible for loss, damage or theft of individual’s property or belongings on the site. You will agree to comply with appropriate conduct and use of facilities. You will also adhere to attire suitable for the activity.

Charges apply per session. No refunds will be made in the case of non attendance by a participant.

The facilitator reserves the right to exclude anyone from the session on medical grounds or excessive lateness. Warriors may make reasonable changes to the times of sessions, provided it gives advanced notice of these changes.  

DECLARATION
By selecting the "signature" button, you are signing this agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this agreement.
I agree to comply with the above terms and conditions. *
I give permission to be photographed and images used for promotion. *
I have completed the medical details above and I consent that, in the event of any illness/accident, any necessary treatment can be administered to me, which may include the use of anesthetics. *
Signature Participant *
Signature Parent (16-) *
Date: *
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