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

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.