Mid Winter Swim Form

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How did you hear about this event?

Add an additional donation?

I am a UK taxpayer and I confirm that this is my own personal donation* and not from a company nor the proceeds of a collection. I would like Crisis to treat this donation and any donations I make in the future and have made in the past 4 years as Gift Aid donations, until I notify you otherwise. With this declaration, Crisis can reclaim 25p of tax on every £1 that I give. I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year, it is my responsibility to pay any difference.

Please remember we need your full name and home address to allow us to claim Gift Aid.

* A personal donation is from one individual and not a collection.

Cardholder information

Use your contact details Use organisation contact details

May we contact you?

Your support means a lot to Crisis. Together we can do amazing things to end homelessness and transform lives.

By post

It is important for us to be able to contact you by post to administer your gift and acknowledge your support. Also, we would like to let you know more about the work of Crisis and how you can help end homelessness through donating, fundraising, campaigning and volunteering. However, if you would rather not receive such information by post, please let us know by calling 08000 38 48 38 or emailing mydetails@crisis.org.uk. Please see our privacy policy.

Email and phone

We'd also love to stay in contact by email, phone and text to let you know about the work of Crisis and how you can help end homelessness through donating, fundraising, campaigning and volunteering. Please see our privacy policy.

Please tick the boxes below to let us know you are happy to hear from us in this way:

Keep me updated by email

Yes No

Keep me updated by phone

Yes No

Keep me updated by SMS (text)

Yes No

As you know we will contact you about the Icebreaker challenge as part of your participation in the event to the email address you supply above. Please email swim@crisis.org.uk at any time if you do not wish to receive these emails and if you have any other questions or concerns related to the event.

We are grateful you are taking part in this fundraising event for Crisis, please note that taking part in this event is not without risk and you are responsible for reading our safety guidance and FAQ section thoroughly, and ensuring that you are taking part safely.

* I agree that I have read the safety guidance and FAQ section for the Crisis Icebreaker.

Crisis Icebreaker Tooting

Icebreaker Tooting

How many attendees?

Which tier?

Are you registering as part of an organisation?

Are you taking part in the solo race or relay (team of 4)?

Are you over 0?

Date of birth

Organisation information

Attendee information

Add an additional donation?

Cardholder information

May we contact you?

By post

Email and phone