ENTRY SUMMARY SHEET
SHAWMUT AQUATIC CLUB LONG COURSE TEAM SPECIALTY MEET
at the
UNIVERSITY OF CONNECTICUT, STORRS, CT
JUNE 22-24, 2001

Any swimmer whose entry is accepted will, for himself/herself, his/her heirs, 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, CONNECTICUT SWIMMING, SHAWMUT AQUATIC CLUB, and THE UNIVERSITY OF CONNECTICUT for any and all injuries suffered by him/her at said meet.  Furthermore, any member of your association, no matter spectator, coach, or participant is responsible for any damages they may have done against any of the before mentioned.

CLUB NAME:  ____________________________________CODE:  __________

ADDRESS:  __________________________________________________

CITY:  ______________________  STATE:  ___________     ZIP:  ___________

NAME OF CONTACT PERSON:_________________________________________

CONTACT PERSON ADDRESS:_________________________________________

_________________________________________________________________

CONTACT PERSON PHONE NUMBER:  _____________ E-Mail _______________

COACH'S NAME_________________________________

CLUB OFFICIAL:  __________________________________________________

SIGNATURE:  _____________________________________________________

NUMBER OF INDIVIDUAL EVENTS:  _______ @ $3.00/EVENT  TOTAL:  ______

NUMBER OF INDIVIDUAL EVENTS:  _______ @ $4.00/EVENT  TOTAL:  ______