Membership Form PAR-Q - PHYSICAL ACTIVITY READINESS IMPORTANT - PLEASE COMPLETE BEFORE TAKING PART This questionnaire helps identify whether you should seek medical advice before increasing your level of physical activity. Answer all questions honestly and tell the session leader about anything that may affect your safe participation. 1. PARTICIPANT DETAILS Full Name Date of Birth Address Postcode Email Mobile Number 2. HEALTH SCREENING QUESTIONS 1. Has a doctor ever said that you have a heart condition or that you should only take part in physical activity recommended by a doctor? YesNo 2. Do you ever experience chest pain, pressure or tightness during physical activity or at rest? YesNo 3. In the past 12 months, have you lost balance because of dizziness or lost consciousness? YesNo 4. Do you have a bone, joint, muscle or other physical problem that could be made worse by exercise? YesNo 5. Are you currently taking prescribed medication that may affect your ability to exercise safely? YesNo 6. Do you have asthma, diabetes, epilepsy, a respiratory condition, allergy, or any other medical condition that a coach or activity leader should know about? YesNo 7. Are you pregnant, have you recently given birth, or has a healthcare professional advised you to modify physical activity? YesNo 8. Is there any other reason why you should not take part in physical activity or why you may need additional support? YesNo 3. IF YOU ANSWERED YES TO ANY QUESTION Please give brief details below. You may be asked to obtain advice from an appropriate healthcare professional before taking part. RRAMS coaches and volunteers do not provide medical clearance. 4. EMERGENCY CONTACT Name Relationship Emergency Contact Number OPEN WATER SWIM WAIVER & DECLARATION OPEN WATER SWIMMING INVOLVES INHERENT RISK All participants swim and take part at their own risk. Open water conditions can change quickly and may include cold water, reduced visibility, uneven or slippery entry points, weeds, wildlife, waves, currents, other water users and the risk of collision, panic, illness or injury. 1. FITNESS & SWIMMING ABILITY I confirm that I am fit enough for the session I have chosen and will swim within my own ability and experience. 2. SAFETY INSTRUCTIONS I will attend any required safety briefing and follow all reasonable instructions from RRAMS coaches, activity leaders and water-safety personnel. 3. EQUIPMENT & CONDITIONS I am responsible for using suitable equipment and clothing for the conditions and understand that RRAMS may modify, delay, shorten or cancel a session where safety requires it. 4. PERSONAL RESPONSIBILITY & RISK I understand that open water swimming and other RRAMS activities carry inherent risks and I am responsible for participating within my own limits. 5. ILLNESS, INJURY & EMERGENCY ACTION If I experience concerning symptoms, I will stop and seek assistance. I consent to reasonable emergency first aid being provided if required. 6. CONDUCT & VENUE RULES I will behave responsibly and comply with reasonable instructions and venue rules. 7. PERSONAL PROPERTY I remain responsible for my own clothing, equipment, valuables and personal property. 8. PHOTOGRAPHY & SOCIAL MEDIA CONSENT YES - I consent to photographs/video of me being used by RRAMS.NO - I do not consent to photographs/video of me being used by RRAMS. 9. PARTICIPANT DECLARATION & CONSENT I confirm the PAR-Q information is complete and accurate. I have read and accept the Open Water Swim Waiver and RRAMS safety requirements. Participant Full Name Date Signature - please type your full name Parent/Guardian Name - if participant is under 18 For under-18s, a parent/legal guardian must review this document and provide photography consent on their behalf.