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Place: 340 South Ocean Blvd. Anchor Park - 1/2 mile south of Atlantic Avenue on A1A in Delray Beach Time: 8 a.m. Registration 9:30 a.m. Start Distance/Course: One-way ocean mile swim Race Registration Individual Swimmer $25 Team Registration (10+ Swimmers) $20 Per Swimmer Pay with one check Checks Payable to: City of Delray Beach Mail Registration to: Delray Beach Ocean Rescue 340 South Ocean Blvd. Delray Beach, FL 33483 Divisions: Mens and Womens 14 & under to 70+ 13 age divisions in 5 year increments Awards: 1 st , 2 nd , 3 rd Medals All age groups T-Shirts: All competitors will receive a long sleeve T-shirt with entry Parking: Free parking at Anchor Park until 11:30 a.m. You must pay the meters if you park along A1A. Refreshments: There will be a variety of refreshments for all competitors after the race. Open Water Swim Warning: Ocean Swimming is a dangerous activity which may result in bodily injury up to and including death. Lifeguards will be on paddleboards and all the lifeguard towers will be open. Paramedics will be on alert during this event if further assistance is needed. Water temperatures are in the mid 70’s and air temperatures range from 50 to low 70’s. For Additional Information: Call, 561-243-7352 [email protected] Registration Form: Name____________________________________ Age_______Male________Female____________ Address__________________________________ City _____________________State____________ Zip _________Email_______________________ Phone____________________________________ Emergency #______________________________ Make Check Payable To: City of Delray Beach (Sorry, No Refunds) Mail Check and Form To: Delray Beach Ocean Rescue 340 South Ocean Blvd. Delray Beach, FL 33483

T-Shirts: Registration Form - Club Assistant Information... · T-Shirts: All competitors will receive a long sleeve T-shirt with entry Parking: ... Do you or any dependents have any

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Page 1: T-Shirts: Registration Form - Club Assistant Information... · T-Shirts: All competitors will receive a long sleeve T-shirt with entry Parking: ... Do you or any dependents have any

Place: 340 South Ocean Blvd. Anchor Park - 1/2 mile south of Atlantic Avenue on A1A in Delray Beach

Time: 8 a.m. Registration 9:30 a.m. Start

Distance/Course: One-way ocean mile swim

Race Registration Individual Swimmer $25 Team Registration (10+ Swimmers) $20 Per Swimmer Pay with one check

Checks Payable to: City of Delray Beach

Mail Registration to: Delray Beach Ocean Rescue 340 South Ocean Blvd. Delray Beach, FL 33483 Divisions: Mens and Womens 14 & under to 70+ 13 age divisions in 5 year increments

Awards: 1st, 2nd, 3rd Medals All age groups

T-Shirts: All competitors will receive a long sleeve T-shirt with entry

Parking: Free parking at Anchor Park until 11:30 a.m. You must pay the meters if you park along A1A.

Refreshments: There will be a variety of refreshments for all competitors after the race. Open Water Swim Warning: Ocean Swimming is a dangerous activity which may result in bodily injury up to and including death. Lifeguards will be on paddleboards and all the lifeguard towers will be open. Paramedics will be on alert during this event if further assistance is needed. Water temperatures are in the mid 70’s and air temperatures range from 50 to low 70’s. For Additional Information: Call, 561-243-7352 [email protected]

Registration Form:

Name____________________________________ Age_______Male________Female____________ Address__________________________________ City _____________________State____________ Zip _________Email_______________________ Phone____________________________________ Emergency #______________________________ Make Check Payable To: City of Delray Beach (Sorry, No Refunds) Mail Check and Form To: Delray Beach Ocean Rescue 340 South Ocean Blvd. Delray Beach, FL 33483

Page 2: T-Shirts: Registration Form - Club Assistant Information... · T-Shirts: All competitors will receive a long sleeve T-shirt with entry Parking: ... Do you or any dependents have any

Release Form (Mandatory) I, the undersigned, intending to be legally bound, do hereby for myself, my dependents, heirs, and executors, waive and release any and all rights and claims for damages which I may have against the City, their employees, representatives and agents for any injuries which I may suffer in connection with my participation in the Delray Beach Ocean Mile Swim on January 5, 2014. Do you have dependents who will be participating in the event ? ___Yes ___No If yes, list their names and ages 1.________________________________________ 2.________________________________________ 3.________________________________________ Do you or any dependents have any disability, handicap or other condition, temporary or permanent, or take any medication, which would require special assistance during the event. ___Yes ___No If yes, please detail any special assistance necessary: ____________________________________________ At various times, the City of Delray Beach photographs events to be submitted to the local media. By participating in the City of Delray Beach Ocean Mile Swim I hereby authorize the City of Delray Beach to reproduce, copy, exhibit, publish, broadcast or distribute any and all tapes or photographs. ____________________________________________ Print Name ____________________________________________ Relationship to Dependent(s) ____________________________________________ Sign Name ___________________________ Date

Delray Beach Ocean Mile Swim

Sunday, January 5 th 2014