Shark dive form test

Participation in the Shark Dive is dependant on the completion of medical forms and having the necessary sign off to take part. Completing the form below does not guarantee you a place in the event.*

I would like to take part in the SIA Shark Dive.

Once your form is submitted someone from the fundraising team will get in touch to complete your registration.

Name*

First Last

Address*

Street Address Address Line 2 Town/City County Postcode

My email address is:*

Confirm email address:*

Contact telephone number:*

Does your company assist staff in fundraising or offer matched-funding?*

Yes - they do allow staff to fundraise
No - they do not allow staff to fundraise
Yes - they do offer matched-funding
No - they do not offer matched-funding
I'm not sure if they allow staff fundraising, or if they offer matched-funding schemes

We provide a fundraising pack. Would you prefer?*

A pack sent by post
An electronic version to be mailed to you
Both

As part of the fundraising pack we provide a SIA t-shirt please let us know what size you require.*

Small
Medium
Large
Extra large

We are working closely with Blue Planet to make this event accessible for as many people as possible and will work with all participants to try to ensure that any access requirements can be met.

Do you consider yourself to have a disability?*

Yes
No

Which date would you prefer to take part on? (We'll try to accommodate your preference depending on availability)*

Friday 9 February 2024 (2pm or 4pm)
Saturday 10 February 2024 (2pm or 4pm)

Fundraising declaration and acknowledgement of registration fee

By signing the declaration to participate in this event, I acknowledge that the event has a fundraising target of £500 (not including the registration fee or Gift Aid) and I agree to raise sponsorship money to that amount or above. I agree to send all sponsorship monies raised to SIA no later than four weeks after the event date, and will inform SIA as soon as possible if there are any circumstances which may hinder my ability to reach the specified fundraising target in order to discuss the options for participation. I further acknowledge that the event has a registration fee of £50 and my registration will not be processed until this has been received by SIA.

Please check the boxes below to accept the conditions outlined above.*

I agree to the fundraising target for this event (£500)
I agree to pay the registration fee of (£50) to reserve my place in this event

Fitness declaration*

By signing this declaration to participate in this event, I acknowledge and understand that diving is an incredibly strenuous physical challenge, and that I am participating at my own risk. I agree to complete any medical forms deemed necessary by the Blue Planet diving team, and seek approval from a medical professional if needed.

I agree to the above, and will seek appropriate medical advice if necessary prior to undertaking this challenge.

Terms and conditions of participation*

I agree that in registering for this event, I am taking part in an activity in support of SIA, who are managing elements of the event, but that the dive itself is facilitated by a third-party company, Blue Planet Aquarium. Only data necessary to the activity will be shared with this third party, and they will not contact participants at any time before, during or after the event without express consent. In taking part in this event on behalf of SIA, I also give permission for SIA to use any photographs, videos or testimonials taken throughout the course of the event to be used to further raise funds or awareness for the charity throughout all media channels.

I agree to the terms and conditions of participation

We would like to keep you informed about our campaigning and services, appeals and others ways you can support our work. Your support and involvement with SIA helps us to empower spinal cord injured (SCI) people and their families to live fulfilled lives. Are you happy for us to contact you in the future using the details provided above?*

Yes please
No thank you

CAPTCHA

We are working closely with Blue Planet to make this event accessible for as many people as possible and will work with all participants to try to ensure that any access requirements can be met.

Fundraising declaration and acknowledgement of registration fee

After you submit this form you should be taken to a confirmation page if this doesn't happen please return to the form and check for errors.