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Lifeguard Checkout Swim Registration

Please complete the following form to register for a lifeguard checkout swim for the 2012 Distance Swim Challenge.

First Name:
Last Name:
Gender:	Male Female
Birthdate (mm/dd/yyyy):
Email:
Phone:
Emergency Contact Name:
Emergency Contact Phone:
Which checkout swim are you registering for?	2.4-mile swim 4.8-mile swim 10k swim 12.6-mile swim
By indicating your acceptance, you understand, agree, warrant and covenant as follows: I understand that participating in this checkout swim (the "swim") is potentially hazardous, and that I should not enter and participate unless I am medically able and properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident that may occur while I am traveling to or from the swim, during the swim, or while I am on the area where the swim is being held. I also am aware of and assume all risks associated with participating in this swim, including but not limited to falls, contact with other participants, effect of weather, traffic and conditions of the ocean. I hereby indemnify and hold harmless each of the organizers of the DISTANCE SWIM CHALLENGE ("Swim Event"), including all its officers, agents, consultants and other representatives and associates and all their members, volunteers, sponsors, the relevant city councils, the County of Los Angeles, the State of California and Instrumentalities, medical and paramedical practitioners and personnel, and all other persons involved in the organisation, conduct and promotion of the Swim Event and their respective employees, servants, agents, contractors, consultants and officers ("Swim Event Organizers") from and against any and all liability for loss and damage, costs or expenses that I or any person under my legal responsibility, whether arising under Statute, from negligence, personal injury, death, property damage, infringement of third party rights or otherwise, which I have or at any time in the future may have arising from or connected with the Swim. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties, or otherwise.
I agree to the above waiver:
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