Clean Water for Schools
Children's Swim Program
Sign Up To Swim for Haiti on Sunday, January 28, 2018
Which Swim would you like to do? (You can change your mind later)
Full Swim 10 km: $110
Short Swim 1.5km: $60
Choose one: you can change your mind later
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Emergency contact and best way to reach them
Provide name and contact information for a contact in case of a emergency
What is your age? (optional)
18 or under
Prefer not to say
I, as a participant of Swim for Haiti, agree the following terms are true:
I do not have any medical ailments, physical limitations, or mental disabilities that will affect my ability to participate in Swim for Haiti.
I recognize that no participants, sponsors, or organizers of this event are responsible for my personal safety or my well-being.
I waive my right to seek legal action against any organizers, sponsors, or participants of Swim for Haiti. Risks include, but not limited to, harmful danger, bodily harm, injury,or death as a result of my participation in Swim for Haiti. These risks can be both foreseeable or dangers that may not be obvious or reasonably foreseeable during participation time.
Acceptance of the waiver
I accept the terms of the liability waiver and take responsibility for my own safety
I DO NOT accept the liability waiver and will not participate in the event
Electronic Signature of the Waiver
I would like to swim for Haiti on January 28th, 2018 and help support Haiti! I understand that a swimmer fee of $110 (or $60 for 1.5km swim) is required. I will help raise money for the swim's charitable causes
Please check the box to confirm
Copyright Swim for Haiti 2018