Swimmer Self Assessment Form Waikiki Swim Club is staffed by unpaid volunteers, with jobs and family obligations. We will try to respond to your form submission in a timely fashion, but please understand that responses may be delayed and are not guaranteed. Mahalo. * Required Fields (you must complete these fields or the form submission will fail) *First Name: *Last Name: *Email Address: *Please confirm email Address: *Age: *Residence (State/Country): *Dates on Oahu: *Please explain why you are contacting Waikiki Swim Club; please be as specific as possible (races, membership, casual swims, etc.) Where are you staying on Oahu? Waikiki North Shore Windward Leeward Coast Other Location: *1. What is your swimming experience/background (competitive, age group, high school, college, masters?) *2. What is your current average weekly swimming distance over the past 3 months? *3. What, if any, are your other atheletic/excercise activities? *4. What are your times for a mile (1.6 km) swim, or more? *5. What is your 100 yard/meter pool swim time? for repeat intervals of: *6. Do you have experience in ocean swimming? If yes, where? 7. If you have done any ocean swim races in Hawaii, which did you do and what year? 8. Is there anything else we should know? Please submit any questions to email@example.com WAIVER & RELEASE: By submitting this form I acknowledge and accept the following: I know that swimming in the pool or in the ocean may be dangerous. I am aware of and assume all risks in any casual swim resulting from contacting Waikiki Swim Club. I acknowledge that casual swims are informally arranged and not sanctioned by Waikiki Swim Club. Waikiki Swim Club cannot guarantee that a suitable swimming opportunity will be available, regardless of your swimming skills and experience. In consideration of this swimmer assessment being accepted, I, the undersigned, intend to be legally bound, hereby, for myself, my heirs, executors and administrators, waive and release any and all claims for damages I may have against any instructors, coaches, volunteers, sponsors, the University of Hawaii, the Waikiki Swim Club, the City and County of Honolulu and the State of Hawaii resulting from my involvement in any casual swim directly or indirectly related to submitting this form. I accept the terms of the waiver & release: Yes You must check "Yes", that you accept the terms of the waiver & release, in order to participate with any group swims. Check the "I'm not a robot" box, answer any questions that appear, then click on the "Submit Now" button. Visit www.tectite.com for free FormMail software.