Name *

First Name

Last Name

Birthdate *

MM

DD

YYYY

Cell phone *

(Something you'll bring with you the day of the swim.)

(###)

###

####

Home address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Miscellaneous safety and comfort gear

WA Boater Education card

Horn or Whistle

Type IV throwable device

Fixed VHF radio

Handheld VHF radio

Fire extinguisher

Head

Emergency contact *

First Name

Last Name

Emergency contact phone *

(###)

###

####

Waiver *

Liability Release: As a condition of participating in the Mercer Island Marathon Swim, I agree to attend the mandatory briefing the morning before the start of the event, and will abide by the event rules and regulations including water safety determinations. On behalf of myself and my heirs, and intending to be legally bound, I hereby certify that I am physically fit and have not been otherwise informed by a physician. I acknowledge that I am aware of the risks inherent in participating in open water swimming events and in training for same, including permanent disability and death, and agree to assume all of those risks. AS A CONDITION OF MY PARTICIPATION IN THE MERCER ISLAND MARATHON SWIM AND ANY ACTIVITIES INCIDENT THERETO, I HEREBY WAIVE ANY AND ALL RIGHTS TO CLAIMS FOR LOSS OR DAMAGES TO MY PERSON OR PROPERTY, INCLUDING ALL CLAIMS FOR LOSS OR DAMAGES CAUSED BY NEGLIGENCE, ACTIVE OR PASSIVE, OF ANY OF THE FOLLOWING: HOST FACILITIES, NOWSA (NORTHWEST OPEN WATER SWIMMING ASSOC, INC), EVENT SPONSORS, EVENT COMMITTEES, VOLUNTEERS, AND ANY INDIVIDUALS OFFICIATING, SUPERVISING AND/OR OTHERWISE INVOLVED IN CONDUCTING THIS EVENT.

I have read and agree to the above Waiver.

Event understanding *

I understand that 1) I will be a part of this swim from start to end and may be on the water for over 9 hours, 2) I will not be able to leave the event for fuel, food, or a bathroom break, 3) in the event of an emergency, I may need to assist swimmers into my boat, 4) a NOWSA official will be on board during the event, 5) the swimmers and the event organizer will be counting on me to make good judgement calls regarding the health and safety of the swimmers, 6) that additional information will be provided, and that I should ask any and all questions about my responsibilities before the day of the event.

I understand the demands of this event.