SEND ENTRIES TO

Dawn Ebbetts
Exeter Sprints Meet Secretary
18 Cullen Way
Exeter, NH  03833
E-mail:  Poipl@mediaone.net

 

NAME                                                                                                    TEAM INITIALS _____              

ADDRESS  __________________________________________________________ 

CITY/STATE/ZIP ______________________________________________________

CONTACT                                                         
PHONE:
(        )                                 E-Mail:  _____________________                             

COACH                                                              
PHONE:
(        )                                E-Mail:  _____________________
                            

  E-Mail Confirmation of Entry should be sent to:  ____________________________________________________

 GIRLS ENTRIES: # _________   x $2.50 (electronic entries)  = _________       $ 3.00 (hand entries) ________

  BOYS ENTRIES: # _________   x $2.50 (electronic entries)  = _________       $ 3.00 (hand entries) ________

   TOTAL ENTRIES: # _________   x $2.50 (electronic entries)  = _________       $ 3.00 (hand entries) ________

NAMES AND PHONE NUMBERS OF S&T and STARTERS:

_______________________________________________________

_______________________________________________________

_______________________________________________________

Any swimmer whose entry is accepted will, for himself, his heirs, executors, and administrators, waive and release any and all rights and claims for damages he may have against United States Swimming, New England Swimming, Exeter Swim Team, Phillips Exeter Academy and any volunteer for or any employee of the above, for any and all injuries or losses suffered by him at said meet.

Signed  __________________________________________________________________                                                                                                                         

                                                            Club Official