Bonaire EcoSwim Entry Form

The 2nd Annual Deep Blue 5k Swim, Metric Mile Swim, and Ocean Festival

Saturday, December 7th 2002

 

You may print this form or Register online by clicking here.

 

All swimmers must complete this form and sign the Liability Release. The US$75.00 entry fee includes: swim entry, welcome dinner, T-Shirt and swim cap. All entries must be received by the Entry Deadline of November 15th, 2002!

Name:               ________________________________, ___________________________________

                        Last,                                                                        First

Address:           __________________________________________,  ________________, _____, ______    _________        

Street,                                                                                              City,                                  State,     Zip Code      Country            

Daytime phone: ________________,        Evening phone: _________________,      E-Mail: _________________      

Sex:      Male  /  Female              Date of Birth: ____/____/____     Age on Race Day: ______

            Circle one                                                           MM     DD      YY

 

Events (please circle):                        Deep Blue 5k solo swim           M  /   F

                                                            Deep Blue 5k with fins             M  /   F

                                                            Metric Mile solo swim              M  /   F

                                                            Metric Mile with fins                M  /   F     

You may swim both the Metric Mile and the 5k event (see discounted dual event entry fee on next page), however, keep in mind the timeline as we will not delay the start to wait for swimmers.

 

The 200 Meter Fun Swim is open to kids and adults alike and there is no Entry fee.  If you or your family wish to participate, please just let us know how many so we have an idea.  Official registration will be on-site on race day.  

How many participants?  ____   Comments (age & gender):  __________________________________________

 

AUTHORIZATION AND EVENT PROMOTION:

I agree to be filmed and photographed by the official and authorized photographers of this event under the conditions authorized by the Host and Meet Directors, and give the event organizers (host and meet director) the right to use my name, picture, likeness, and biographical information before, during and after the period of my participation in this event to promote the event in which I compete or to promote the success of the team on which I competed.  I will not promote third party sponsors, causes, or charities unless pre-approved by the Meet Director. 

 

LIABILITY RELEASE:

I, the undersigned participant, intending to be legally bound, hereby certify that I am physically fit and have not been otherwise informed by a physician.  I acknowledge that I am aware of all the risks inherent in swimming (training and competition) including possible permanent disability or death, and agree to assume all of those risks.  AS A CONDITION OF MY PARTICIPATION IN THIS SWIMMING EVENT OR ANY ACTIVITIES INCIDENT THERETO, I HEREBY WAIVE ANY AND ALL RIGHTS TO CLAIMS FOR LOSS OR DAMAGES INCLUDING ALL CLAIMS FOR LOSS OR DAMAGES CAUSED BY THE NEGLIGENCE, ACTIVE OR PASSIVE, OF THE FOLLOWING: AQUA MOON ADVENTURES, THE CLUBS, HOST, MEET DIRECTORS, MEET SPONSORS, MEET COMMITTEES OR ANY INDIVIDUALS OFFICIATING AT THE MEETS OR SUPERVISING SUCH ACTIVITIES.  I further agree to abide by and be governed by the rules and regulations of this event.  I also specifically acknowledge that: 1) I am aware of all the risks inherent in open water swimming and agree to assume those risks and 2) I understand that Events outside of one's country present many types of additional risks.  Finally, I understand that there will be no refunds given for any reason including event cancellation. I have read this entire Liability Release and understand its content without exception.

Swimmer’s Signature: ____________________________________            Date: _______________ 

Parent’s Signature: _______________________________________           Date: _______________

(required for swimmers age 18 and under) 

 

 

 
 
Bonaire EcoSwim - Entry Form

Page 2

please be sure that page 1 is attached

 

Name:               ________________________________, ___________________________________

                        Last,                                                                        First

 

 

Entry Fee for each swimmer, single event (either 5k or Mile) is US$ 75.00= US$75.00                      ___________

 

Entry Fee for solo swimmer second event (both 5k and Mile)*, add US$ 45.00+ US$45.00                ___________

*(does not include additional t-shirt, cap or dinner)

 

Swimmers T-Shirt, circle one (included with entry fee):     M    /    L     /      XL

 

 

To purchase additional T-Shirts (US$15.00 each), please indicate sizes & amounts:

 

M____ / L____ / XL____             Total # of additional T-Shirts  ______ x US$15.00 =             US$    __________     

 

 

To purchase additional guest passes for Welcome Dinner (US$15.00 each):           

Total # of additional guests:   ______ x US$15.00 =             US$    __________    

 

 

Total Fees enclosed (Swimmer entry fee, Additional T-Shirts, Additional dinners):                US$ ____________       

 

All fees are non-refundable. Incomplete entries will not be accepted.

 

Make checks payable in (US$) to Aqua Moon Adventures and mail with both pages of this completed and signed entry form to:        Aqua Moon Adventures, P. O. Box 9448, Coral Springs, Florida 33075    USA