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Mustard Tree Cancer Support Centre sponsored, “Into the Blue” for people after a cancer diagnosis
Step
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8
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"Into the Blue" is an 8 week course for people living with or recovering from cancer.
The following guidance for participants on an Into the Blue course has been created by Dr Roy, Consultant Oncologist at Plymouth NHS Trust.
Please contact South Devon Chill for information about other courses.
This course is taking place at Bigbury Beach.
The date of this course Thursday 12th September
Swim time
*
10am
11am
Participant name
*
First
Last
Address
*
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Participant phone number
*
Participant email (please confirm your email)
*
Enter Email
Confirm Email
What is your gender?
*
Participant Date of Birth
*
Day
Month
Year
I am living with or recovering from cancer
*
Yes
No
How did you find out about this course?
I am starting new treatment during the 8 week course period
*
Yes
No
I am on treatment with chemotherapy or immunotherapy
*
Yes
No
I have bone metastases
*
Yes
No
I have had a blood clot
*
Yes
No
I have any of the following in my chest cavity: Tumours or lesions, enlarged lymph nodes or a pleural effusion
*
Yes
No
If you answered Yes to ANY of the statements in Part 1 then we need written approval from your oncology team that you have discussed this course with them and they agree you can participate at your own risk. Contact us if you are interested in a place but need to get approval.
ellie@chilluk.org
If you can answer Yes or Not Applicable (N/A) to ALL the statements below, you CAN continue and apply for a place on the course
My surgery was more than three months ago
*
Yes
No
N/A
I completed radiotherapy at least 6 weeks ago
*
Yes
No
N/A
I do not have any tumours or lesions in my brain
*
Yes
No
I do not any have open wounds (including a line)
*
Yes
No
Emergency contact name
First
Last
Emergency contact number
*
Which of the following best describes your ethnicity
*
White
Mixed
Asian or Asian British
Black or Black British
Please list any medical conditions and or allergies
Do you have any physical or mental health conditions or illnesses that have lasted or are expected to last more than 12 months or more?
*
Yes
No
If yes, do these physical or mental health conditions or illnesses have a substantial effect on your ability to do normal daily activities?
*
*IMPORTANT PLEASE READ
Due to the physical nature of the course we do require all participants to be able to swim 50m of a pool unaided and walk approximately 1 mile unaided. At low tide it can be a long walk to and from the water, this is on top of the walk from the car park to the beach which can be rocky depending on the location.
I can swim 50m of a pool unaided
*
Yes
No
Can you walk at least 1 mile unaided?
*
Yes
No
Since you answered no to the last question, unfortunately you do not meet the criteria for this course. Please contact
info@chilluk.org
for further information
What or who inspired you?
Changing robe options
Please choose one of the following
I have access to a waterproof changing robe for the duration of the course?
*
Yes
No
I have access to a robe/dressing gown and a warm jacket to go over the top of it?
*
Yes
No
If you would you like to purchase a long sleeve Moonwrap before the beginning of the course for £87 including delivery, please order below
*You may wish to wait until your place on the course is confirmed before buying your changing robe.
Buy Moonwrap robe
Consent
I agree to any photos and video footage of me to be used by and other organisations who are associated with Chill for promotional purposes
*
Yes
No
I agree to allow Chill to hold my personal information for Chill Courses
*
Yes
No
I am happy to be contacted for Chill or their partners for follow up surveys
*
Yes
No
Where did you hear about the course
*
Referral from a doctor / social prescriber
Oncology team
Cancer Support Centre
Social media
A friend
Search engine
Open Water Swimming Disclaimer
Consent name
*
First
Last
Consent
*
I agree to the Open Water Swimming Disclaimer
The following terms and conditions apply to all swimmers (“you”) attending this open water swim course organised by CHILL SOUTH DEVON CIC (“we” or “us”). Please ensure you have read and understood the following.
1. Acceptance of terms and conditions.
By booking or attending a swim session with us, you accept these terms and conditions and they will form part of the contract between us.
2. Sessions.
In order to attend this session, you must be able to swim a minimum of 50m freestyle continuously and without rest. You must also be able to tread water easily. If in our opinion you are unable to comply with these minimum requirements then we may cancel your place on the session and if you have already paid for the session we will offer you a credit.
3. Illness, medical conditions and acceptance of risk.
It is your responsibility to ensure that you are medically fit to swim and that at the start of a session you notify us of any relevant medical conditions. If you are showing signs of any Covid19 symptoms, we ask you to not turn up to the lesson. By booking or attending a session with us you confirm to us that:
(a)
You are fit to swim in open water
(b)
You meet the minimum requirements for swimming ability set out in paragraph 2 of these terms and conditions.
(c)
All personal information you have provided to us is correct and not misleading; and
(d)
You understand the dangers of swimming in open water and you agree to swim at your own risk We will not be liable for any accidents or injuries arising from swimming with us, save that nothing in these terms and conditions will limit the liability of any person for death or personal injury caused by negligence.
4. Safety and general rules
Swimmers are responsible for their safety, actions and behaviour on any part of the site property including the changing area. Safety for all is our paramount concern and we have the right to remove anyone on, in or around the site who gives us any concern whatsoever with regard to safety. You enter the water entirely at your own risk and we shall not be liable for any accidents or injuries you sustain. Open water swimming by its nature presents risks to the swimmer over and above those found in a swimming pool and by booking an open water session you accept that you are acting at your own risk and that we shall not be liable for any injury or any other matter suffered by you in the session or as a result of the session (including without limitation for any water borne diseases and/or any injuries caused by wildlife in/on the water.
5. Limitations of Liability
Whilst every reasonable precaution is taken by us to ensure security and safety at our sessions, we shall not in any way be liable for any loss or damage arising in any way from our sessions or venue we use. However, nothing in these terms and conditions shall limit the liability of any person for death or personal injury caused by negligence. Any claim against us arising from attendance at one of our sessions must be notified in writing to us within six months from the day of the relevant session and we shall not be liable for any claim notified to us after this time. In any event, we shall not be liable to you:
(a)
for any purely economic loss, for consequential or indirect losses or for any loss of profit or opportunity;
(b)
(where the claim is insured) for any loss which we are unable to recover from any insurer;
(c)
(where the claim arises as a result of something which was done or not done by a third party) for any loss which we are unable to recover from that third party; and
(d)
for any loss which is greater than the fee paid by you for the relevant session. In the event that you cause harm, damage loss or injury to any other person or property during the session, you agree to indemnify us and reimburse us for all claims, losses, damages, expenses (including reasonable legal fees) and any other liability suffered by us as a result of such harm, damage, loss or injury caused by you. We shall not be liable for any loss or theft of your personal possessions and all property left by you in changing rooms, the car park or anywhere else on or in the vicinity of our venue is done so at your own risk.
6. Governing law
English Law shall govern these terms and conditions and you agree that any disputes shall be resolved exclusively by English courts.
Date of consent
*
Day
Month
Year
Signature
*
Phone
This field is for validation purposes and should be left unchanged.
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