Knocktober-Register

Athlete Name

First NameLast Name
Gender
Birthdate

MonthDayYear
Age on Race Day
T-Shirt Size
USA-Swimming Member Number
(N/A is acceptable if purchasing a 1 day membership 3 days prior to the race. There will be a $15 charge)
Participant Email (if under 18, parent email)
Team
Team Site (location)

3k Knock Out Series

⚠️ ATTENTION ATHLETES: Qualifying Time Required

You must submit a provable qualifying time to enter this event.

Penalty Fee: $100 fine for entries without proof.

Verify your credentials before registering to avoid penalties.

Boys Qualifying Times Girls Qualifying Times

5:58.19/ 5:23.49 500y/400m Free 6:22.79/ 5:41.79

12:20.99/ 11:09.19 1000y/800m Free 13:10.29/11:50.79

20:46.99/ 21:25.69 1650/1500m Free 22.01.19/22:43.49

$75.00 Quantity

11 years old & Over (no time restrictions)

$60.00 Quantity

Splash and Dash

(9-12 year olds) 500m Swim and Beach Run

$40.00 Quantity

Enter coupon

Total

Credit Card

Apple Pay

Emergency Contact Details

ON Race Day
Emergency Contact Name

First NameLast Name
Emergency Contact Email
example@example.com
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Previous Number of Open Water Swims
Date

MonthDayYear
Date

Payment Details
Confirmation Email
Release and hold Harmless Agreement: In consideration of being permitted to participate in this swim meet, and for other good and valuable consideration, the undersigned, for himself, his successors and assigns, hereby releases and forever discharges Potomac Marlins, PVS, Virginia Swimming, and its Board of Directors, USA Swimming Inc., Montclair MPOA and each of their respective officers, agents, employees, members, successors, and any other persons in any way connected with this meet, form any and all liabilities, claims, demands, actions, or causes of action of whatever kind of character arising out of or in connection with said event. Further, the undersigned shall indemnify and hold harmless Potomac Marlins PVS, Virginia Swimming, USA Swimming Inc., Montclair MPOA and the officers, trustees, agents, employees, and members of the foregoing and all other persons in any way and claims arising out of or in connection with any injury, including death, or alleged injury of damage to property sustained or alleged to have sustained in connection with or to have arisen out of said event. When entering this event, you are acknowledging this wavier of liability.
Signature of parent of participant or participant 18 and older
Should be Empty:

Emergency Contact Details