1.NAME

2.CLUB

3.ARE YOU A MEMBER OF GWENT YFC

4.DATE OF BIRTH - (NO UNDER 16'S)

5.I CONFIRM THAT I AM A CONFIDENT SWIMMER AND I AM CAPABLE OF SWIMMING IN COLD WATER.

6.DO YOU HAVE ANY PRE EXISITING INJUIRIES OR MEDICAL CONDITIONS? IF SO PLEASE LIST. COUNTY WILL BE IN TOUCH TO DISCUSS

7.I CONFIRM I WILL WEAR SUITABLE FOOTWEAR AND CLOTHING BEFORE, DURING AND AFTER THE RAFT RACE.

8.I CONFIRM I WILL SUPPLY AND WEAR A HELMET AND LIFE JACKET FOR THE DURATION OF THE RAFT RACE.

9.CONTACT EMAIL AND NUMBER

10.I CONFIRM THE RAFT IS SAFE AND FOLLOWS ALL THE RULES ISSUED