SEPTEMBER SPLASH
REGISTRATION FORM
Name _______________________________________________
Race Day Age _______ Sex ______
Address _____________________________________________
City ________________________________________ State _____
Zip Code ___________
Email Address _________________________________ Phone __________
List any medical alert ____________________________________________
Event: _____ 2 mile swim _____ 1/4 mile swim ______
1 mile Swim
PARTICIPATION AGREEMENT: WAIVER & RELEASE
In consideration for acepting this entry and the granting of the right to
participate in this event, I the undersigned, intending to be legally bound,
hereby, for myself, my heirs, waive and release for any and all claims, damages,
costs or expenses which may arise against Wildwood Crest Swim Team, the Boroughof
Wildwood Crest, and L & M Computer Sports, 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 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.
_______________________________________________ Date _______________
signature
___________________________________________________________
signature of parent / guardian if under 18