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Sign Up To Swim for Haiti on Sunday, January 26, 2020
Which Swim would you like to do? (You can change your mind later)
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Full Swim 10 km: $150
Short Swim 1.5km: $80
Choose one: you can change your mind later
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Name
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First
Last
Email
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Phone Number
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Emergency contact and best way to reach them
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Provide name and contact information for a contact in case of a emergency
What is your age? (optional)
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18 or under
19-25
26-35
36-50
Over 50
Prefer not to say
T-Shirt Size
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Small
Medium
Large
X-Large
Liability Waiver
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
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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
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First
Last
Confirmation
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I would like to swim for Haiti on January 26th, 2020 and help support Haiti! I understand that a swimmer fee of $150 (or $80 for 1.5km swim) is required. I will help raise money for the swim's charitable causes
Please check the box to confirm
Submit