Swimming Race Registration Form

Swimming Race Registration Form
Location: The Old Swimming Hole: 374 Airport Rd, Manteo, NC 27959
Race Dates: June 14, 2025
Time: 8:00am

RACE DESCRIPTION:
• The races are all in the water starts, triangular courses with right shoulder Turns.
• The 1 m and 2 m will be marked with the repeating course.
• Wet suits are allowed IF the water temp is below 78 degrees.

Benefitting the Outer Banks Family YMCA.
Proceeds ensure that everyone has access to life-changing
programs at the YMCA.
Participant Information
Full Name*

First NameLast Name
Age*
Date of Birth*

MonthDayYear
Date
Gender*
Phone Number*
Email*
example@example.com
T-Shirt Size*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Person*

First NameLast Name
Emergency Person Phone Number*
Relationship to Emergency Contact Person*
Registration Payments
*ALL Swimmers MUST purchase a USAT card prior to racing.

You can purchase a 1 day card for $15.00.

Must Show us card before you enter the water.

My Products*

$39.00

1Meter

$49.00

2 Meter

$59.00

Total

$0.00

Terms/ Waiver/ Release
Type a question*

I will follow the rule and regulations of the race event.I am in good shape, health, and condition.I don't have any medical condition or medical history that will be affected if I participate in this event.I acknowledge that this race requires physical activity and there are possible risks and danger.I release the race event organizers for any responsibility in case of an accident, illness, or injury.I allow taking my photos or the procedure images that can be used for the event portfolio or advertising.I confirm that all information in this registration form is accurate and true.
Participant's Signature*

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Date Signed*

MonthDayYear
Date
Parent/Guardian Signature (If below 16 years old)*

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Date Signed*

MonthDayYear
Date
Should be Empty:

Participant Information