Observer Report

Use this form to submit the official record of a successful long-distance swim. The report should be completed by the observer after the swim.

"*" indicates required fields

Type of Swim*

Solo Swimmer Details

Swimmer Name*

Swimmer ID Number*

Relay Swimmer Details

Swimmer 1 Name*

Swimmer 1 ID Number*

Swimmer 2 Name*

Swimmer 2 ID Number*

Swimmer 3 Name*

Swimmer 3 ID Number*

Swimmer 4 Name*

Swimmer 4 ID Number*

Swimmer 5 Name*

Swimmer 5 ID Number*

Swimmer 6 Name*

Swimmer 6 ID Number*

Swim Details

Swim Route*

Date of Swim*

Swim Distance*

Average Water Temperature*

Category*

Skins

Wetsuit

Assisted

Stroke*

Confirm swimmer(s) swam in terms of CLDSA swim rules

Yes

Start Time*

End Time*

Total Time*

Conditions and Marine Life Observations*

CLDSA Observer*

Skippers Name*

I hereby confirm:*

The above information is a correct and true record of the completed swim

I understand and acknowledge that as a CLDSA Observer I will not hold CLDSA, its committee, members, observers, pilots, sponsors, event organisers and third party service providers liable for any direct or indirect loss, injury, death or damage

I consent to the use of any personal information by the CDLSA, committee, members and third party service providers for the purposes it was provided and in compliance with the Protection of Personal Information Act 4 of 2013