NAME OF TEAM:_________________________________ ABBREVIATION:_____________

TEAM ADDRESS:___________________________________ PHONE:_____________________

___________________________________

___________________________________

COACH:___________________________________________ PHONE:_____________________

CONTACT PERSON:_________________________________ PHONE:_____________________

TEAM E-MAIL ADDRESS:___________________________________________________________

(required)

NO. OF ENTRIES BOYS:_______ X $4.00 = ______

GIRLS:_______ X $4.00 = ______

TOTAL = ______

ENTRY DEADLINE: OCTOBER 12, 2001

MAKE CHECK PAYABLE TO: YSS SWIM TEAM

MAIL ENTRY & CHECK TO:
MS. DARLENE MCGRATH
45 TRUMAN DR.
RANDOLPH, MA 02368

ANY SWIMMER WHOSE ENTRY IS ACCEPTED WILL FOR HIMSELF, HIS HEIRS, OR EXECUTORS AND ADMINISTRATORS, WAIVE AND RELEASE ANY AND ALL RIGHTS AND CLAIMS FOR DAMAGES HE/SHE MAY HAVE AGAINST UNITED STATES SWIMMING, NEW ENGLAND SWIMMING, SOUTH SHORE YMCA STRYPERS SWIM TEAM AND THE SOUTH SHORE YMCA FOR ANY AND ALL INJURIES SUFFERED BY HIM/HER AT SAID MEET.

________________________________________________

AUTHORIZED CLUB OFFICIAL'S SIGNATURE

NAME:__________________________________________

TITLE: __________________________________________

NAME:__________________________ PHONE:____________________________

NAME:__________________________ PHONE:____________________________

NAME:__________________________ PHONE:____________________________