Central Zone Open Water Championship Liability Release Form
Event Date: Clinic-June 16, 2022, Race-June 17, 2022
Event Address: Lake Andrea Beach-9900 Terwall Terrace, Pleasant Prairie, WI
Sanction # WI2022-###OW
Contact us at sfrye@pleasantprairiewi.gov or px3swimteam@gmail.com

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Email *
Please Pick the Best Option *
Participant Full Legal Name (First, Middle Initial, Last) *
Name of Parent/Guardian (must be a parent/guardian filling out this form if participant is a minor)
Email of participant or parent/guardian (if participant is a minor) *
Phone number of participant or parent/guardian (if participant is a minor) *
Swim Team or Organization Represented *
Days you/participant will be competing in (or at) the event *
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