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SEPTEMBER SPLASH REGISTRATION FORM 2008
Last Name ________________________________________
First Name ________________________________________
Address _____________________________________________
E-Mail Address _______________________________________
City ___________________________________ State _____
Zip Code ___________
Race Day Age _______ Sex ______ Phone ________________________________
List any medical alert _____________________________________________________
Event ______ 2 mile Swim _____ 1/4 mile swim ______ 1 mile Swim
PARTICIPATION AGREEMENT: WAIVER & RELEASE
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In consideration for accepting this entry and the
granting of the right to participate in this event, I, the
undersigned, intending to be legally bound, hereby, for myself
and my heirs, waive and release for any and all claims, damages,
costs or expenses which may arise against Wildwood Crest Swim
Team, L&M Sports, the Borough of Wildwood Crest, sponsors, event
representatives, successors, and assignees and/or any other
person whomsoever for any and all injuries, illnesses, including
death, that may result from my participation in said event. I
represent and affirm that I am, or my child is, in proper
physical condition to participate in this event as verified by a
licensed physician and have sufficiently trained for the
completion of this event. The Undersigned has read and
voluntarily signed this release and waiver. |
Signature: __________________________________ Date:
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Signature of parent / guardian if under 18
__________________________________________________________
Thank you very much! Wildwood Crest Dolphins Swim Team
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