Bonaire EcoSwim

The 4th^d Annual Deep Blue 10k, 5k Swim, Metric Mile Swim and Ocean Festival

Saturday, November 6^th 2004

Entry Form

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: welcome dinner, T-Shirt and swim cap. All entries must be received by the Entry Deadline of October 15^th, 2004!

Name:

Last, First, MI

Sex: Male Female Date of Birth: / / Age on race day:

Address:

Street Apt / Suite #

City State/Province Zip

Country

Daytime phone Evening phone

E-Mail Address

Events (please circle):

10k Solo M/F

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

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): _____________________________________

Bonaire EcoSwim - Entry Form

Name:

Last, First, MI

AUTHORIZATION AND EVENT PROMOTION:

I agree to be filmed, photographed, taped, quoted or otherwise mentioned (without compensation) by the Event Director (also known as Meet Director), or by anyone authorized by the Event Director. This includes but is not limited to the official and authorized photographers, writers, hosts, or sponsors of this event under the conditions authorized by the Event Director. I give the Event Director, and anyone authorized by the Event Director, the right to use (without compensation) my name, picture, likeness, quotes, and biographical information, whether audio or visual, before, during and after the period of my individual or team participation in this event. I will not promote third party sponsors, causes, or charities unless pre approved by the Event Director. I understand that there will be no refunds given for any reason including event cancellation.. 

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, VOLUNTEERS, AS WELL AS THE RESPECTIVE OFFICERS, DIRECTORS, AGENTS AND EMPLOYEES OF ALL OF THE FOREGOING ENTITIES 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 I am aware of all the risks inherent in open water swimming and agree to assume those risks. I also understand that events outside of one's country present many types of additional risks and that the standard of care may not be what I am accustomed to. Any dispute, controversy or claim of any kind whatsoever, including but not limited to torts allegedly resulting in injuries during the swim race or at the hotel facilities, shall be settled by the American Arbitration Association in accordance with its Commercial Rules and judgment on the award rendered by the arbitrator may be entered in any court having jurisdiction thereof. This arbitration agreement covers all claims as set forth herein between the undersigned and Aqua Moon Adventures and/or its sponsors, agents, directors, officers, volunteers, and employees, including the race committee, and will continue from the time of the acknowledgment of this agreement by the undersigned until it is otherwise terminated in writing by the agreement of the parties. 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

Name:

Last, First,

Entry Fee US$ 75.00 = US$ 75.00

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