STR Swim Camp 2008

Registration and Participation Release Form

Fill in this form and fax (866-469-3614) or email to STR by Monday, March 17. Registrations received after that date will be accommodated as much as possible. For questions: Sharon Kidd Loving - kidd@swimmingtechnology.com or 850-385-9803

Please read carefully before signing. This is a release of liability and waiver of certain legal rights.

I, ___________________________, the enrolled participant and/or parent/guardian of the participant agree and understand that swimming is a hazardous activity. I recognize that there are risks inherent in the sport of swimming, including but not limited to, paralyzing injuries and death.

The participant hereby agrees to participate in this program and hereby agrees to indemnify and hold harmless Swimming Technology Research, Inc. (“STR”), its officers, directors, instructors, consultants, agents, or subcontractors against any liability resulting from injury that may occur to the participant while participating in any STR activity. The participant also agrees to indemnify STR for any damages incurred arising from any claims, demand, action or cause of action by the participant.

The participant authorizes any representative of STR to have the participant treated in any medical emergency during their participation in any STR program. Further, the participant and/or parent/guardian agree to pay all cost associated with medical care and transportation for the participant.

I have noted on the back of this form any medical/health problems of which the staff should be aware.

I have carefully read the above liability release and sign it with full knowledge of its contents and significance.

Signature (parent, if minor) __________________________________Date_____________

Participant name______________________________ Age ____ Height_____ Weight ____ Gender____

Home phone________________ Work phone_______________ E-mail___________________

Registration for: ___Camp 1   ___Camp 2        T-shirt size:   __S  __M  __L  __XL

Name as on credit card_________________________________

Street____________________________ City__________________ State______ Zip________

Credit card number __________________________________ Exp______________

For more information: info@swimmingtechnology.com or call 850-385-9803 in the USA