Medical Certificate – Competitive Sport Activity

For foreign athletes. To be completed and signed by a licensed physician (doctor). This certificate must confirm no contraindications for competitive open water swimming.

1) Physician details

Physician full name (licensed physician)

Medical license / registration number (if applicable)

2) Athlete details

First name

Surname

Date of birth

Place of birth

Address / Residence (street, city, country)

ID / Passport number (optional)

3) Medical statement

I, the undersigned licensed physician, hereby certify that the above-mentioned subject, according to the clinical examinations and investigations carried out, does not present any contraindication to participate in competitive open water swimming / lifesaving / surflifesaving..

No contraindications to competitive open water swimming / lifesaving / surflifesaving.

This certificate is valid for one (1) year from the issue date.

4) Dates (mandatory)

Issue date (mandatory)

Expiration date (mandatory)

Place (city/country)

5) Physician signature & stamp (mandatory)

Physician’s signature (mandatory)

Physician’s stamp (mandatory)

Note: The Organisation reserves the right to request an Italian translation if needed for verification. The athlete is responsible for providing a valid certificate on race day.