APPLICATION PROCESS
2016
Event Director: Robert Singer
273 Haviland Road
Queensbury, NY 12804 /
fax: 518-743-9315
www.lakegeorgeswim.com/Marathon
Event Overview
Thank you for your interest in the Lake George Marathon Swim, covering 32 miles between Ticonderoga and the Village of Lake George. The 2016 Marathon Swim is scheduled for September 17, when water temperatures are expected to be 66°F to 70°F, though significantly lower and higher water temperatures have been recorded in mid-September. Swimmers desiring to attempt this swim must be prepared for the challenges of the extreme distance, cold water temperatures, cold weather, turbulent waters, and nighttime swimming, among others.
The Lake George Marathon Swim is also an opportunity for relay teams to raise money for a charity of their choice and for charities that support Lake George. Each team is asked to raise a minimum of $600, to be split evenly between Lake George charities and the individual’s chosen charity. Each individual will determine the beneficiaries of any funds raised in excess of the minimum, and the Swim encourages support for charities supporting Lake George. For more information, please see http://www.lakegeorgeswim.com/marathon/charities.
Swim Support
Each relay swim requires
· One motorized support boat. This is each swim’s “home base,” which will carry crew, equipment and food, and will provide primary safety support. It is the relay team’s responsibility to provide a support boat that is rated to carry all swimmers, required crew and equipment and able to facilitate all team members’ removal from the water. We endeavor to secure boats for rent for teams that cannot provide their own boat. The rental costs, which we currently expect to be $400 - $500, will be the relay team’s responsibility.
· One boat captain. Each motorized support boat must have a dedicated captain. Providing a captain is primarily the relay team’s responsibility, though the Swim will also attempt to identify available captains.
· One official observer. The Swim organizers will provide an official observer for each swim.
· One kayak.
· Kayakers. Kayakers will provide primary navigation and nutrition support to the swimmers. 5- and 6-person relay swimmers will provide kayak support to their teammates. 2-, 3- and 4-person relays require 2 kayakers. These teams are encouraged to provide their own kayak and kayakers, and the Lake George Marathon Swim will recruit kayaks and kayakers. If you use a kayak and/or kayakers identified by the Swim, a rental fee may apply and the relay team may be required to make a donation to the volunteer kayaker’s charity of choice.
· Crew. While kayakers are the primary swimmer support, each 2- and 3-person relay team may provide up to 2 additional crew members, taking into consideration their boat’s capacity and comfort.
· All participants, crew, kayakers and volunteers are responsible for their own food and water.
APPLICATION PROCESS2016
(continued)
Application Process
You should be aware of the following deadlines, which are further discussed below:
Jan. 15, 2016 Application Form
Jan.-Feb., 2016 Event registration and deposit with a deadline to be provided
June 1, 2016 Completed Medical Form
July 31, 2016 Qualifying Swim Form, and
2016 USMS card (or FINA equivalent or One Event Registration), and
final payment.
Submission: The Relay Team Captain is responsible for collecting and submitting all Application materials except Medical Forms (if applicable) to the Event Director. Individuals submitting Medical Forms should submit them directly to the Event Director.
Application Form: You are encouraged to submit as soon as possible the basic Application Form containing biographical and contact information for you and your team, your open water swimming résumés and your 2016 swim plans. Accepted relays will be conditionally approved until all application materials and final payment have been received by the Swim.
$100 Deposit: Once an application is approved or conditionally approved, we will send a link with a deadline for event registration and payment of the non-refundable deposit. After the deadline, we may offer the spot to another team.
Medical Forms: Medical Forms are required for 2- and 3-person relays. As soon as possible, swimmers should schedule an appointment after January 1, 2016 with their physician. The swimmer and physician should only sign the form after the physical exam and any required follow-up are completed. Swimmers must also provide the Swim organizers with any health status updates up to the commencement of the Swim.
Qualifying Swim Form: Swimmers who have completed a Qualifying Swim should submit this form along with documentation supporting your swim as soon as possible. Swimmers who have not completed a Qualifying Swim must provide details of a Qualifying Swim or an Assessment Swim no later than July 31, 2016. We may ask swimmers to provide additional plans to demonstrate specific abilities (e.g., night swimming or swimming in colder water) as part of their Qualifications.
Final payment: This is the final payment for your registration fees, net of deposits paid. The Relay Team Captain is responsible for the entirety of this payment.
USMS membership card: All swimmers are required to provide proof of membership with United States Masters Swimming (or a FINA equivalent). Swimmers may submit a 2016 membership card or the USMS One Event Registration Form. Fees for USMS or FINA equivalent memberships are not included in fees for the Lake George Marathon Swim.
RELAYAPPLICATION
2016
Event Director: Robert Singer
273 Haviland Road
Queensbury, NY 12804 /
fax: 518-743-9315
www.lakegeorgeswim.com/Marathon
Application Instructions
Please be sure your application includes:
q Biographical Information, Emergency Contact Information, Swimming Background and signed Participant Declarations for all swimmers
q Signed Liability Waivers for all swimmers
q Biographical information and Emergency Contact Information for all additional support personnel
q Description of your Charity and your Goals: see http://www.lakegeorgeswim.com/marathon/charities
Relay Information
Number of swimmers in relay (maximum of 6): / (all swimmers must be at least 18 years of age)Team Captain: / Email:
Phone:
Swimmer #2:
Swimmer #3:
Swimmer #4:
Swimmer #5:
Swimmer #6:
Additional Support
Boat Captain: / (if provided by your team)Kayaker #1: / (for 2-, 3- and 4-person relays)
Kayaker #2: / (for 2-, 3- and 4-person relays)
Crew #1: / (for 2- and 3-person relays)
Crew #2: / (for 2- and 3-person relays)
Fees
Relay swim fee: $600
Deposit: $100 (If your application is accepted or conditionally accepted, we will provide a link to register for the Lake George Marathon Swim and to submit your non-refundable deposit.)
Please remember that each team is responsible for providing for a motorized support boat, kayaks and kayakers. Fees for these items are not included in the Lake George Marathon Swim registration fees. Swimmers are also required to be members of US Masters Swimming (or FINA equivalent) at the time of the Swim.
Charity and Goals
On a separate sheet, please include a description of your team’s goals for the Lake George Marathon Swim, the charity you will be supporting and your fundraising goals. We will request periodic updates on your fundraising progress to track the aggregate impact of the fundraising element of the Lake George Marathon Swim.
RELAYAPPLICATION
2016
Event Director: Robert Singer
273 Haviland Road
Queensbury, NY 12804 /
fax: 518-743-9315
www.lakegeorgeswim.com/Marathon
Each relay team member should complete this page and sign the Participant Declarations (following) page.
Provide Biographical and Emergency Contact information for crew members, kayakers and boat captains.
Biographical Information
Name: Home phone: Circle preferred
Address: Cell phone: Circle preferred
City, State: Email:
Postal code: Date of birth: / /
Country: Age: Gender: M ☐ F ☐
T-shirt size: Unisex or Ladies’ cut 2016 USMS #:
Emergency Contact
Name: Relationship:
Home phone: Email:
Cell phone:
Swimming Background
Please list some of your most recent and notable open water events: (attach documentation)
Event / Water tempLocation / Finish time & place
Distance / Winning time
Event / Water temp
Location / Finish time & place
Distance / Winning time
Event / Water temp
Location / Finish time & place
Distance / Winning time
Event / Water temp
Location / Finish time & place
Distance / Winning time
Each swimmer’s background should demonstrate the following:
☐ Long distance/duration ☐ Colder water swimming ☐ Night swimming ☐ Rough water swimming
Highlights of open water swims planned for the current year. These swims should continue to validate the fitness indicated above and should demonstrate a plan to fill any gaps in capabilities.
Swim 1 / Location / DistanceSwim 2 / Location / Distance
Swim 3 / Location / Distance
RELAY
APPLICATION
2016
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Participant Declarations
• I wish to attempt a lengthwise crossing of Lake George.
• I have read, understand, and agree to abide by the rules and guidelines of the Lake George Marathon Swim, which are available at www.lakegeorgeswim.com/marathon/rules.
• I certify that I consider I am physically and mentally fit to undertake the Lake George Marathon Swim and have not been otherwise informed by a medical practitioner.
• I will advise the organizers of any changes in my medical condition that arise before the Marathon Swim.
• I acknowledge and understand that attempting the Lake George Marathon Swim is an extreme test of my swimming ability, physical conditioning and mental toughness. I am aware of the risks inherent in attempting a marathon swim and the training for such an event, including possible permanent disability or death. I agree to accept and assume all those risks.
• I acknowledge and accept that the provision of certification for a qualifying swim and medical/health condition in no way implies any representation by the Lake George Marathon Swim that the applicant has completed sufficient training or is sufficiently fit or healthy to attempt the Lake George Marathon Swim.
• I am solely responsible for assessing whether I have achieved an appropriate amount and type of training, fitness and health before embarking upon my swim attempt, and I will not make the attempt if for any reason I have failed to achieve this, while still acknowledging that I shall remain solely responsible for all lost fees and expenses.
· I agree to follow the directions of the Event Director, Safety Monitor, my boat captain, and my escort kayaker. If they declare that the swim is over for me for any reason I will cooperate and leave the water in accordance with their directions.
· I understand that unpredictable circumstances may result in the cancellation or change in course of the Lake George Marathon Swim before or during the event. Refunds of entry fees may not be refunded. Any refunds will be at the discretion of the Event Director and will depend on the costs and commitments made at the time the event is cancelled.
I hereby waive any and all rights, to the fullest extent permitted by applicable law, to claim for loss or damages against the Lake George Marathon Swim and/or any body affiliated thereto and any of the officials supervising, observing or organizing the event, which arise out of my participation in attempting the Lake George Marathon Swim, or any activities incidental thereto.
Signature
PRINT Full Legal Name:
Signature: Date:
MEDICALFORM
2016
Event Director: Robert Singer
273 Haviland Road
Queensbury, NY 12804 /
fax: 518-743-9315
www.lakegeorgeswim.com/Marathon
Personal Information
Name: Date of birth: / / Age:
Insurance provider/policy number: Gender: M ☐ F ☐
Instructions
· 2- and 3-person relay swimmers must submit both Part 1 and Part 2 as part of the application. Incomplete Medical Forms will cause the application to be delayed or rejected.
· This form must be completed after January 1, 2016 and submitted to the Lake George Marathon Swim prior to June 1, 2016. Until we receive fully completed Medical Forms from each relay team member of 2- and 3-person relays indicating their doctors’ opinions of fitness to attempt the Lake George Marathon Swim, approval of the team’s Application will be Conditioned on such receipt and acceptance.
· Keep a copy of your Medical Form for your records.
PART 1: MEDICAL HISTORY (to be completed by Swimmer)
If you answer “yes” to any of the questions below, you must attach further explanation.
1. Have you ever suffered at any time from the following:
a. Ear trouble, earache, discharge or deafness? YES NO
b. Sinus trouble? YES NO
c. Chest disease, including asthma, bronchitis, collapsed lung? YES NO
d. Blackouts or fainting? YES NO
e. Fits or any nervous disorders, including persistent headaches or concussion? YES NO
f. Anxiety, “nerves” or nervous breakdowns? YES NO
g. Heart disease? YES NO
h. High blood pressure? YES NO
i. Diabetes or hypoglycemia? YES NO
2. Do you regularly or frequently take medications with or without a prescription? YES NO
3. Are you currently receiving medical care or have you consulted a doctor in the last year? YES NO
4. Have you ever had a medical exam for an athletic endeavor with an unsatisfactory result? YES NO
5. Have you ever been rejected for life insurance? YES NO
6. Have you been to the hospital in the last year? YES NO
7. Do you smoke or use illegal drugs? YES NO
8. Do you have any allergies to medications? YES NO
9. Do you have any orthopedic problems? YES NO
10. Do you wear any prostheses? YES NO
Swimmer’s Signature
I certify that to the best of my knowledge I am in good health and that I have not omitted any information that may be relevant to my fitness to attempt the Lake George Marathon Swim. I authorize my doctor to provide details of my past or present medical history to representatives of the Lake George Marathon Swim if asked to do so. I also agree that the information on this form can be disclosed to persons directly connected with my Swim, including my boat pilot and persons providing medical care.
Signature: Date:
MEDICALFORM
2016
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Patient Information
Name: Date of birth: / /
PART 2: DOCTOR’S EXAMINATION
· The above named swimmer wishes to be examined to determine his/her physical fitness to participate in the 32 mile Lake George Marathon Swim. Please note that this is an extremely challenging physical and mental undertaking.