2007 Ed Gaw Amelia Island Open Water Challenge

USMS Sanctioned by Florida LMSC: Sanction#: Pending Application

USA-Swimming Approval #: Pending Application

Entry forms available at www.fernandinabeachflorida.com

Events: 5K open water swim

1-mile open water swim

Both events open to USMS and USA-Swimming registrants.

Saturday

June 30, 2007

USMS Sanction No.: pending

Race Start: 8:30 a.m. (approximately)

Junior swimmers will launch 5 minutes

prior to the masters swimmers (Subject

to the discretion of race officials)

Location: Fernandina Beach, Florida.

Race finish area and check-in located at Main Beach

at the intersection of Fletcher Avenue and Atlantic

Avenue.

Entry Fee: $30.00 before June 24, 2007

$40.00 deck entry and

entries received after June

24, 2007

All participants receive event T-shirt, swim cap, and other items. Awards will be distributed at the race finish.

Deck entries will receive a T-shirt on an as available basis.

Event participation limited to 300 swimmers – early registration encouraged.

Awards will be given to the overall top 5 male and female finishers and to top 3 finishers in each age group.

All swimmers must be registered with USMS or USA swimming ($15.00 on deck registration)

Race Day: 7:00 a.m. check-in and deck registration at the race finish

area located at Main Beach.

The City of Fernandina Beach and other drivers will provide transportation for all participants to the starting points* of the

race at the Jasmine St. (1 mile event) and Simmons Road (5K event) beach accesses. There will be a course briefing on

Saturday morning prior to the start of the swims. An awards ceremony and breakfast will be provided to all participants at

the race finish area that is Main Beach Park. Non-swimmers must pay $6.00 for the breakfast.

* Race starting and ending points may be adjusted due to current direction at the race officials’ discretion.

Course Description and Safety:

1-mile Event – race start located at Jasmine St. beach access

5-K Event – race start located at the Simmons Road beach access

All events finish at Main Beach located at the intersection of Atlantic Avenue and Fletcher Avenue.

COURSE DIRECTION (START AND FINISH POINTS) MAY BE ALTERED FOR SAFETY REASONS AT THE DISCRETION

OF RACE OFFICIALS

There will be a 2.5-hour time limit for racers to complete either course. Check-in at the finish line is mandatory for all

racers. The safety of the swimmers will be priority. There will be Coast Guard Auxiliary boats, and lifeguards in the water

for the protection of the swimmers. EMTs and lifeguards will also be on the beach to assist swimmers in need.

Event Contacts and Coordinator(s): Kathy Russell 904/277-7350 * krussell@fbfl.org

Chris Gaw 407/721-2837 * cgaw@cfl.rr.com

Isabel Gaw 904/277-4328 * izzygaw300@bellsouth.net

2007 Ed Gaw Amelia Island Open Water Challenge

RACE REGISTRATION FORM

Online Registration can also be found at www.active.com

Name: Age (on race day):

Address:

City: State: Zip:

Home Phone: Business/Cellular Phone:

Email:

Emergency contact: Phone:_______________________

Event : (Circle One) 1 mile-USMS 1 mile-USA-S 5K USMS 5K USA-S

USMS or USA Swimming Membership No.:

PROVIDE COPY OF USMS or USA-Swimming MEMBERSHIP CARD OR PROOF OF MEMBERSHIP IN A FOREIGN ORGANIZATION .

Daily membership available on deck for $15.

Team Name (if applicable):

Male / Female (circle one)

Handicap assistance needed? yes / no (circle one) If yes, what type?:

Amount Enclosed: $ __________________ $30 before June 24, 2007 / $40 thereafter

T-shirt size: (Circle One) S M L XL XXL

Make Check Payable to: Amelia Island Open Water Challenge

Mailing Address: Amelia Island Open Water Challenge

Fernandina Beach Parks and Recreation Dept.

2500 Atlantic Ave.

Fernandina Beach, FL 32034

Event Contacts and Coordinator(s): Kathy Russell 904/277-7350 * krussell@fbfl.org

Chris Gaw 407/721-2837 * cgaw@cfl.rr.com

Isabel Gaw 904/277-4328 * izzygaw300@bellsouth.net

Ed Gaw Amelia Island Open Water Challenge

Waiver for Adults

Liability Waiver

I, the undersigned participant, intending to be legally bound, hereby certify that I am physically fit and have not been otherwise informed by a physician.

I acknowledge that I am aware of all the risks inherent in Masters Swimming (training and competition), including possible permanent disability or death,

and agree to assume all of these risks. AS A CONDITION OF MY PARTICIPATION IN THE MASTERS SWIMMING PROGRAM OR ANY ACTIVITIES

INCIDENT THERETO, I HEREBY WAIVE ANY AND ALL RIGHTS TO CLAIMS FOR LOSS OR DAMAGES, INCLUDING ALL CLAIMS FOR LOSS OR

DAMAGES CAUSED BY THE NEGLIGENCE, ACTIVE OR PASSIVE, OF THE FOLLOWING: UNITED STATES MASTERS SWIMMING, INC., THE

LOCAL MASTERS SWIMMING COMMITTEES, THE CLUBS, HOST FACILITIES, MEET SPONSORS, MEET COMMITTEES, OR ANY INDIVIDUALS

OFFICIATING AT THE MEETS OR SUPERVISING SUCH ACTIVITIES. In addition, I agree to abide by and be governed by the rules of USMS. Finally,

I specifically acknowledge that I am aware of all the RISKS inherent in open water swimming, and agree to assume those RISKS.

Print name: Signature of Participant: Date: _________

Waiver for Minors

LIABILITY RELEASE AND INDEMNIFICATION FORM OF NON-MEMBER

I, the undersigned participant and parent, request voluntary participation for minor to participate in the AMELIA ISLAND OPEN WATER CHALLENGE (activity)

on June 30, 2007 (date) which begins at 8:30am (time) and ends at 1:00 pm (time) sponsored by THE CITY OF FERNANDINA BEACH all of which are

hereinafter referred to as the “activity.” I consent to my/minor’s participation in the activity and acknowledge that the minor and I fully understand my/minor’s

participation may involve risk of serious injury or death, including losses which may result not only from my/minor’s own actions, inactions or negligence, but also

from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the event or activity is being conducted, and/or the rules of

play of this type of event or activity. I understand that if I have any risk concerns, I should discuss the risks associated with my participation with the activity

coordinators and event staff, before I sign this document and before the activity begins.

Release – Minor’s Rights:

In consideration of allowing Minor Participant to participate in this event, I hereby release and hold harmless ________________________________________ Club,

the City of Fernandina Beach, USA Swimming, its local swimming committees and their members of its board of directors, officers, employees, volunteers, other

participants, and agents (collectively, the “Released Parties”), of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities

that Minor Participant may have or sustain with respect to any and all damage and/or injury, of any type, arising out of his or her participating in this USA Swimming

event. I also agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

___________________________________ (Print name of minor) _____________________________________(Signature of minor) _______________ (Date)

Release – Parents’/Guardians’ Rights:

In consideration of allowing Minor Participant to participate in this event, I hereby release and hold harmless the Released Parties, of and from, and do discharge and

waive, any and all claims, demands, losses, damages, and liabilities that I may have or sustain with respect to any and all damage and/or injury, of any type, arising

from Minor Participant’s participation in this USA Swimming event. I also agree that if any portion of this agreement is held to be invalid the balance, notwithstanding,

shall continue in full force and effect. I certify that my/minor is in good health and have no physical condition that would prevent participation in this activity.

Furthermore, I agree to use my/minor’s personal medical insurance as a primary medical coverage payment if accident or injury occurs. I consent to emergency medical

treatment in the event such care is required.

___________________________________ (Print name of Parent/Guardian) _____________________________ (Signature of parent) _____________ (Date)

Indemnification by Parent/Guardian:

The undersigned parent/guardian further agrees to indemnify, save and hold harmless the Released Parties from any and all claims, demands, losses, damages and

liabilities for indemnities, contribution or otherwise with respect to any damage and/or injury, of any type, arising from Minor Participant’s participation in this event.

The undersigned also agrees that this Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement extends to all acts of negligence by the Releasee

and is intended to be as broad and inclusive as is permitted by the laws of the State in which the Event(s) is/are conducted and that if any portion thereof is held invalid,

it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

__________________________________ (Print name of Parent/Guardian) ______________________________ (Signature of parent) _____________ (Date)