REGISTRATION - SWIM FOR THE DOLPHINS, JULY 17, 2004
___Single Entry ___ Team
Entry
Name: __________________________________________________________
Address: ________________________________________________________
City: _________________________ State: ______
Zip Code: _____________
Race Day Age ________ Sex: _____ Daytime
Phone: _________________
List any medical alert: ____________________________________________
Swim Team Name: ______________________________________________
Beach Patrol Name: ______________________________________________
T-Shirt size: __ medium __ large __
X large __ XX large
PARTICIPATION AGREMENT, WAVIER AND RELEASE
In consideration for accepting this entry and the granting of the right
to participate, I the undersigned, intending to be legally bound hereby,
for myself, my heirs, assume all risk of injury due to my participation
in this event and waive and release for any and all claims, damages, costs
of expenses which may arise against the Marine Mammal Stranding Center,
the Borough of Wildwood Crest, and the Wildwood Crest Beach Patrol, 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 in proper physical conditions to particiapte in this event as verified
by a licensed physican and have sufficently trained for the completion
of this event. The undersigned has read and voluntarily signed this release
and wavier.
_______________________________________________ DATE: _____________________
signature of participant
_______________________________________________ DATE:
_____________________
signature of parent/guardian, if entrant under
18
Witness: ________________________________________________