DATES:
MAY 1 – 4, 2013
VERY FEW SPOTS REMAINING
Day
Day
Day
Day
1:
2:
3:
4:
Wednesday May 1st
Thursday May 2nd
Friday May 3rd
Saturday May 4th
SAGUARO LAKE:
CANYON LAKE:
APACHE LAKE:
ROOSEVELT LAKE:
+/+/+/10k
9.5 MILES. $150
9 MILES.
$150
15 MILES.
$150
Night Swim. $150
Swim Guidelines: Wetsuits, neoprene suits, floatation and propulsion devices are prohibited for
recognized swims. A swimmer may choose to use a wetsuit for the purpose of participating, but not
competing, in the swim. Updates on each swim will be provided to registered swimmers via e-mail.
Competitor Limits: 25 solo swimmers per day. Preference to those non-wetsuit swimmers signed up
for the most days. Relays of four swimmers are permitted but must provide own motor boat support.
Each relay team must submit entry form and release of liability signed by each swimmer.
Entry Is Not Completed Until:
1. All entry form information is legible and complete. Relays submit all four swimmers entry
information in same envelope with full payment.
2. Dated and signed the accident waiver form by each relay swimmer (only one required for
solo swimmer).
3. Submitted a non-refundable entry fee for the dates of intended swims.
4. Age on the day of the swim must be at least 16 years old. Photo I.D. at check in required.
5. Mailed to: Kent Nicholas / SCAR SWIM, 40 N. Center, Suite 202, Mesa, AZ 85201. No mail
will be accepted requiring a signature.
6. Entries must be received (not postmarked) by Friday, April 5, 2013.
-----------------------------------------------------------------------------------------------------------------------------------------SWIM OVERVIEW
http://openwaterpedia.com/index.php?title=S.C.A.R._Swim_Challenge
Swim Video
http://vimeo.com/49545749
1
ENTRY FORM
ENTRIES MAILED TO:
Kent Nicholas / SCAR SWIM
40 N. Center, Suite 202
Mesa, AZ 85201
DEADLINE: APRIL 5, 2013
CHECKS PAYABLE TO:
ARIZONA AQUATIC DEVELOPMENT FOUNDATION
NAME:________________________________________________________ AGE: ___________
Print First Name, Last Name
DATE OF BIRTH:_____________ SEX: ____
MAILING ADDRESS:____________________________________________________________________
City:____________________________State:____________________________ Zip:________________
PHONE NUMBER:________________________________ E-MAIL________________________________
Indicate Days Swimming And Payment: CHECK DAYS YOU WILL BE SWIMMING
⃝ Day 1: SAGUARO LAKE:
+/- 9.5 MILES.
$150 ($200/
⃝ Day 2: CANYON LAKE:
+/- 9 MILES.
$150 ($200/
⃝ Day 3: Apache Lake:
+/- 15 MILES.
$150 ($200/
⃝ Day 4: Roosevelt:
10k Swim.
$150 ($200/
⃝ ALL FOUR SWIMS (Discounted)
$550 ($725/
TOTAL DAYS SWIMMING ________________________
ALL FOUR SWIMS (Solo or Relay at discounted rate)
X $150 =
Relay)
Relay)
Relay)
Relay)
Relay)
$ _____________
$______________
AMOUNT ENCLOSED WITH ENTRY FEE: $________________(NON-REFUNDABLE)
IF RELAY, TEAM NAME:____________________________________________________________
IF RELAY, NAME OF MOTOR BOAT OPERATOR:__________________________________________
SWIM SUPPORT: CHECK THE NATURE OF SUPPORT YOU HAVE OR NEED
⃝ Will Provide Own Kayak.
⃝ Will Need a Kayak.
⃝ Will Provide Own Kayaker: NAME:______________________________________Age_______
⃝ Will Need a Kayaker.
2
2013 ACCIDENT AND RELEASE OF LIABILITY CONTRACT
I, the undersigned participant, or parent on behalf of a swimmer under the age of 18, intending to be
legally bound, certify that I have (my child has) sufficiently trained to swim in the 2013 Arizona S.C.A.R.
Swim Challenge and that I am (my child is) physically fit and have not been advised otherwise by a
qualified medical person.
I AM AWARE THAT COMPETITIVE LAKE SWIMMING IS POTENTIALLY HAZARDOUD ACTIVITY IN AN
UNCONTROLLED OPEN WATER COURSE ENVIRONMENT AND CARRIES WITH IT THE POTENTIAL FOR
SERIOUS INJURY OR DEATH. I AGREE TO ASSUME ALL RISKS ASSOCIATED WITH THIS EVENT AND ALL
ACTIVITIES INCIDENT THERETO INCLUDING, BUT NOT LIMITED TO: EXTREME PHYSICAL EXERTION,
FALLS, CONTACT WITH OTHER PARTICIPANTS, ROCKS, EVENT EQUIPMENT, WATERCRAFT,
POWERBOATS WITH PROPELLERS, VEHICLULAR TRAFFIC, BOAT TRAFFIC, AQUATIC ANIMALS AND
POTENTIALLY DANGEROUS LAKE ANIMALS, THE EFFECTS OF WEATHER AND COLD WATER, AND
TRAVEL TO AND FROM THIS EVENT. I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS
EVENT. I REALIZE THAT LIABILITY MAY ARISE FROM THE RECKLESSNESS, NEGLIGENCE OR
CARELESSNESS ON THE PART OF THE ENTITIES OR PERSONS NAMED BELOW FROM DANGEROUS OR
DEFECTIVE EQUIPMENT CONTROLLED BY THEM.
Having carefully read the above waiver and all event risks being known and appreciated by me (and my child) and in
consideration of my application and permitting me (or my child) to participate in this event and all activities incident thereto; I
hereby take action for myself and anyone entitled to act on my behalf as follows: (A) WAIVE, RELEASE AND DISCHARGE FROM
ANY AND ALL LIABILITY FROM MY DEATH, DISABILITY, PERSONAL INJURY, PROPERTY THEFT OR ACTIONS OF ANY KINDWHICH
MAY HEREAFTER ACCRUE TO ME INCLUDING MY TRAVELING TO AND FROM THIS EVENT, THE FOLLOWING PERSONS OR
ENTITIES: Kent M. Nicholas, Candice E. Nicholas, Mesa Aquatics Club, Arizona Aquatic Development Foundation, Partners in the
Event and their representatives, Sponsors of the Event and their representatives, and Volunteers of the Event; (B) Indemnify
and hold harmless the entities or persons mentioned specifically or generally from any and all liabilities or claims made as a
result of participation in this event, whether caused by recklessness, negligence of releases or otherwise. I hereby consent to
receive medical treatment which may be deemed advisable during this event and agree to be solely responsible for all costs
relating to medical treatment, transportation and/or evacuation. I certify that no representations have been made to me by
anyone associated with this event concerning the physical condition required of a participant. I certify that I have finished a
Sanctioned Three Mile Swim or further within the past two years and will submit proof upon request. I acknowledge that this
Accident Waiver and Release of Liability contract will be used by S.C.A.R. Swim Challenge and that it will govern my actions and
responsibilities at this event and shall be construed broadly to provide a release and waiver to the maximum extent permissible
under applicable Arizona law. I HAVE READ THIS ENTIRE CONTRACT AND UNDERSTAND ITS CONTENT WITHOUT EXCEPTION.
DATE:__________________________ ENTRANT:________________________________________
(PRINT NAME)
ENTRANT:________________________________________
(SIGN NAME)
PARENT OF ENTRANT (IF UNDER 18)_______________________________________________________
3
2013 ACCIDENT AND RELEASE OF LIABILITY CONTRACT
I, the undersigned participant, or parent on behalf of a swimmer under the age of 18, intending to be
legally bound, certify that I have (my child has) sufficiently trained to swim in the 2013 Arizona S.C.A.R.
Swim Challenge and that I am (my child is) physically fit and have not been advised otherwise by a
qualified medical person.
I AM AWARE THAT COMPETITIVE LAKE SWIMMING IS POTENTIALLY HAZARDOUD ACTIVITY IN AN
UNCONTROLLED OPEN WATER COURSE ENVIRONMENT AND CARRIES WITH IT THE POTENTIAL FOR
SERIOUS INJURY OR DEATH. I AGREE TO ASSUME ALL RISKS ASSOCIATED WITH THIS EVENT AND ALL
ACTIVITIES INCIDENT THERETO INCLUDING, BUT NOT LIMITED TO: EXTREME PHYSICAL EXERTION,
FALLS, CONTACT WITH OTHER PARTICIPANTS, ROCKS, EVENT EQUIPMENT, WATERCRAFT,
POWERBOATS WITH PROPELLERS, VEHICLULAR TRAFFIC, BOAT TRAFFIC, AQUATIC ANIMALS AND
POTENTIALLY DANGEROUS LAKE ANIMALS, THE EFFECTS OF WEATHER AND COLD WATER, AND
TRAVEL TO AND FROM THIS EVENT. I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS
EVENT. I REALIZE THAT LIABILITY MAY ARISE FROM THE RECKLESSNESS, NEGLIGENCE OR
CARELESSNESS ON THE PART OF THE ENTITIES OR PERSONS NAMED BELOW FROM DANGEROUS OR
DEFECTIVE EQUIPMENT CONTROLLED BY THEM.
Having carefully read the above waiver and all event risks being known and appreciated by me (and my child) and in
consideration of my application and permitting me (or my child) to participate in this event and all activities incident thereto; I
hereby take action for myself and anyone entitled to act on my behalf as follows: (A) WAIVE, RELEASE AND DISCHARGE FROM
ANY AND ALL LIABILITY FROM MY DEATH, DISABILITY, PERSONAL INJURY, PROPERTY THEFT OR ACTIONS OF ANY KINDWHICH
MAY HEREAFTER ACCRUE TO ME INCLUDING MY TRAVELING TO AND FROM THIS EVENT, THE FOLLOWING PERSONS OR
ENTITIES: Kent M. Nicholas, Candice E. Nicholas, Mesa Aquatics Club, Arizona Aquatic Development Foundation, Partners in the
Event and their representatives, Sponsors of the Event and their representatives, and Volunteers of the Event; (B) Indemnify
and hold harmless the entities or persons mentioned specifically or generally from any and all liabilities or claims made as a
result of participation in this event, whether caused by recklessness, negligence of releases or otherwise. I hereby consent to
receive medical treatment which may be deemed advisable during this event and agree to be solely responsible for all costs
relating to medical treatment, transportation and/or evacuation. I certify that no representations have been made to me by
anyone associated with this event concerning the physical condition required of a participant. I certify that I have finished a
Sanctioned Three Mile Swim or further within the past two years and will submit proof upon request. I acknowledge that this
Accident Waiver and Release of Liability contract will be used by S.C.A.R. Swim Challenge and that it will govern my actions and
responsibilities at this event and shall be construed broadly to provide a release and waiver to the maximum extent permissible
under applicable Arizona law. I HAVE READ THIS ENTIRE CONTRACT AND UNDERSTAND ITS CONTENT WITHOUT EXCEPTION.
DATE:__________________________ ENTRANT:________________________________________
(PRINT NAME)
ENTRANT:________________________________________
(SIGN NAME)
PARENT OF ENTRANT (IF UNDER 18)_______________________________________________________
4
2013 ACCIDENT AND RELEASE OF LIABILITY CONTRACT
I, the undersigned participant, or parent on behalf of a swimmer under the age of 18, intending to be
legally bound, certify that I have (my child has) sufficiently trained to swim in the 2013 Arizona S.C.A.R.
Swim Challenge and that I am (my child is) physically fit and have not been advised otherwise by a
qualified medical person.
I AM AWARE THAT COMPETITIVE LAKE SWIMMING IS POTENTIALLY HAZARDOUD ACTIVITY IN AN
UNCONTROLLED OPEN WATER COURSE ENVIRONMENT AND CARRIES WITH IT THE POTENTIAL FOR
SERIOUS INJURY OR DEATH. I AGREE TO ASSUME ALL RISKS ASSOCIATED WITH THIS EVENT AND ALL
ACTIVITIES INCIDENT THERETO INCLUDING, BUT NOT LIMITED TO: EXTREME PHYSICAL EXERTION,
FALLS, CONTACT WITH OTHER PARTICIPANTS, ROCKS, EVENT EQUIPMENT, WATERCRAFT,
POWERBOATS WITH PROPELLERS, VEHICLULAR TRAFFIC, BOAT TRAFFIC, AQUATIC ANIMALS AND
POTENTIALLY DANGEROUS LAKE ANIMALS, THE EFFECTS OF WEATHER AND COLD WATER, AND
TRAVEL TO AND FROM THIS EVENT. I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS
EVENT. I REALIZE THAT LIABILITY MAY ARISE FROM THE RECKLESSNESS, NEGLIGENCE OR
CARELESSNESS ON THE PART OF THE ENTITIES OR PERSONS NAMED BELOW FROM DANGEROUS OR
DEFECTIVE EQUIPMENT CONTROLLED BY THEM.
Having carefully read the above waiver and all event risks being known and appreciated by me (and my child) and in
consideration of my application and permitting me (or my child) to participate in this event and all activities incident thereto; I
hereby take action for myself and anyone entitled to act on my behalf as follows: (A) WAIVE, RELEASE AND DISCHARGE FROM
ANY AND ALL LIABILITY FROM MY DEATH, DISABILITY, PERSONAL INJURY, PROPERTY THEFT OR ACTIONS OF ANY KINDWHICH
MAY HEREAFTER ACCRUE TO ME INCLUDING MY TRAVELING TO AND FROM THIS EVENT, THE FOLLOWING PERSONS OR
ENTITIES: Kent M. Nicholas, Candice E. Nicholas, Mesa Aquatics Club, Arizona Aquatic Development Foundation, Partners in the
Event and their representatives, Sponsors of the Event and their representatives, and Volunteers of the Event; (B) Indemnify
and hold harmless the entities or persons mentioned specifically or generally from any and all liabilities or claims made as a
result of participation in this event, whether caused by recklessness, negligence of releases or otherwise. I hereby consent to
receive medical treatment which may be deemed advisable during this event and agree to be solely responsible for all costs
relating to medical treatment, transportation and/or evacuation. I certify that no representations have been made to me by
anyone associated with this event concerning the physical condition required of a participant. I certify that I have finished a
Sanctioned Three Mile Swim or further within the past two years and will submit proof upon request. I acknowledge that this
Accident Waiver and Release of Liability contract will be used by S.C.A.R. Swim Challenge and that it will govern my actions and
responsibilities at this event and shall be construed broadly to provide a release and waiver to the maximum extent permissible
under applicable Arizona law. I HAVE READ THIS ENTIRE CONTRACT AND UNDERSTAND ITS CONTENT WITHOUT EXCEPTION.
DATE:__________________________ ENTRANT:________________________________________
(PRINT NAME)
ENTRANT:________________________________________
(SIGN NAME)
PARENT OF ENTRANT (IF UNDER 18)_______________________________________________________
5
2013 ACCIDENT AND RELEASE OF LIABILITY CONTRACT
I, the undersigned participant, or parent on behalf of a swimmer under the age of 18, intending to be
legally bound, certify that I have (my child has) sufficiently trained to swim in the 2013 Arizona S.C.A.R.
Swim Challenge and that I am (my child is) physically fit and have not been advised otherwise by a
qualified medical person.
I AM AWARE THAT COMPETITIVE LAKE SWIMMING IS POTENTIALLY HAZARDOUD ACTIVITY IN AN
UNCONTROLLED OPEN WATER COURSE ENVIRONMENT AND CARRIES WITH IT THE POTENTIAL FOR
SERIOUS INJURY OR DEATH. I AGREE TO ASSUME ALL RISKS ASSOCIATED WITH THIS EVENT AND ALL
ACTIVITIES INCIDENT THERETO INCLUDING, BUT NOT LIMITED TO: EXTREME PHYSICAL EXERTION,
FALLS, CONTACT WITH OTHER PARTICIPANTS, ROCKS, EVENT EQUIPMENT, WATERCRAFT,
POWERBOATS WITH PROPELLERS, VEHICLULAR TRAFFIC, BOAT TRAFFIC, AQUATIC ANIMALS AND
POTENTIALLY DANGEROUS LAKE ANIMALS, THE EFFECTS OF WEATHER AND COLD WATER, AND
TRAVEL TO AND FROM THIS EVENT. I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN THIS
EVENT. I REALIZE THAT LIABILITY MAY ARISE FROM THE RECKLESSNESS, NEGLIGENCE OR
CARELESSNESS ON THE PART OF THE ENTITIES OR PERSONS NAMED BELOW FROM DANGEROUS OR
DEFECTIVE EQUIPMENT CONTROLLED BY THEM.
Having carefully read the above waiver and all event risks being known and appreciated by me (and my child) and in
consideration of my application and permitting me (or my child) to participate in this event and all activities incident thereto; I
hereby take action for myself and anyone entitled to act on my behalf as follows: (A) WAIVE, RELEASE AND DISCHARGE FROM
ANY AND ALL LIABILITY FROM MY DEATH, DISABILITY, PERSONAL INJURY, PROPERTY THEFT OR ACTIONS OF ANY KINDWHICH
MAY HEREAFTER ACCRUE TO ME INCLUDING MY TRAVELING TO AND FROM THIS EVENT, THE FOLLOWING PERSONS OR
ENTITIES: Kent M. Nicholas, Candice E. Nicholas, Mesa Aquatics Club, Arizona Aquatic Development Foundation, Partners in the
Event and their representatives, Sponsors of the Event and their representatives, and Volunteers of the Event; (B) Indemnify
and hold harmless the entities or persons mentioned specifically or generally from any and all liabilities or claims made as a
result of participation in this event, whether caused by recklessness, negligence of releases or otherwise. I hereby consent to
receive medical treatment which may be deemed advisable during this event and agree to be solely responsible for all costs
relating to medical treatment, transportation and/or evacuation. I certify that no representations have been made to me by
anyone associated with this event concerning the physical condition required of a participant. I certify that I have finished a
Sanctioned Three Mile Swim or further within the past two years and will submit proof upon request. I acknowledge that this
Accident Waiver and Release of Liability contract will be used by S.C.A.R. Swim Challenge and that it will govern my actions and
responsibilities at this event and shall be construed broadly to provide a release and waiver to the maximum extent permissible
under applicable Arizona law. I HAVE READ THIS ENTIRE CONTRACT AND UNDERSTAND ITS CONTENT WITHOUT EXCEPTION.
DATE:__________________________ ENTRANT:________________________________________
(PRINT NAME)
ENTRANT:________________________________________
(SIGN NAME)
PARENT OF ENTRANT (IF UNDER 18)_______________________________________________________
6