Checks payable to: Pageant Swim, 1
Circle Drive,
For further information call
609-347-5466 or visit www.apexswim.com
Swimmer_______________________________________________Age ____
Sex____
(Address)
____________________________________
T-shirt Size: S____ M____ L____ XL____
(Phone - for
cancellations)
This event is open to all swimmers and will be
conducted according to current USA Swimming rules. Swimmer’s age is as of the
day of the race. $20 early entry fee must be enclosed and received prior to
Make checks payable
to: "Pageant Swim" and mail to:
Pageant
Swim
1 Circle
Drive
In consideration for
accepting this entry and granting of the right to participate in this event
I/we, the undersigned intending to be legally bound hereby for myself/ourselves,
my/our heirs, waive and release for any and all claims, damages, costs, or
expenses which may arise against personal damages I may have against Atlantic
City Beach Patrol, the City of Atlantic City, Middle Atlantic Swimming, USA
Swimming and/or any other person whomsoever for any and all injuries, illness,
including death that may result from my participation in said event. I/we
represent and affirm that I/we am/are 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 Waiver and Release.
______________________________________________________________________
Signature
Date
______________________________________________________________________
Parent's
Signature (if under 18)
Date