Name *

First Name

Last Name

Phone *

(###)

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About You *

I confirm I can swim a min 25 metres

Emergency Contact Details *

First Name

Last Name

Phone

(###)

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Please select one of the following: *

I am 16 years old or over. I have answered all of the questions to the best of my knowledge without omitting any information. I confirm that I have assessed my suitability to participate in the activity and declare that I am capable of doing so.

I am 14 - 16 years. I have parent/guardian consent and they have answered all of the questions to the best of their knowledge without omitting any information. I confirm that I have assessed my suitability to participate in the activity and declare that i am capable of doing so.

Disclaimer *

IMPORTANT* Before you proceed – cold water immersion is a risky activity, you must adhere to all safety guidance & instruction. Kallbad has appropriate liability insurance, however, we cannot be responsible for your wellbeing and safety if you do not adhere to advice/instructions, nor disclose information that would affect your swimming ability. 

By checking this box, you acknowledge the risks and are happy to assume full responsibility for all risks involved in the swim.

Consent *

I consent to my photos/video taken for marketing/publicity purposes

I/we agree to the Booking Terms & Conditions