Smith Mountain Lake Open Water Swim Online Entry

First Name:
Last Name:
Entry Fee:
Shirt Size:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Daytime Phone:
Emergency Contact:
Emergency Contact Phone Number:

Release: The following release MUST BE SIGNED and IN THE HANDS OF THE EVENT DIRECTOR before a swimmer may compete. "I, the undersigned participant, intending to be legally bound, do 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 risk inherent in Open Water Swimming (training & competition) including possible permanent disability or death, and agree to assume all of those risks. As a condition of my participation in this Open Water 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 damage caused by negligence active or passive of the following: United States Swimming Inc., United States Masters Swimming, the Local US Swimming Committees, the clubs, host facilities, meet sponsors, meet committees or any individual officiating at the meets or supervising such activities. In addition, I agree to abide by and be governed by the rules implemented for this event. I also specifically acknowledge that i am aware of all the risk inherent in open water swimming and agree to assume those risk. By clicking the submit button on this entry form you hereby fully understand and affirmatively agree to the specific terms of the release language written above.