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North Carolina Open Water Championship Registration Form
Due to COVID Restrictions, registration is limited to ONLY USA Swimming Club swimmers for all events and Buddy Swimmers for the 400M/800M
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USA Swimmer Registration Fee
NON-USA BUDDY Swimmer ONLY Registration Fee-Single Meet USA Swimming Membership Fee included-
USA Swimmer Registration Fee - $35.00
NON-USA BUDDY Swimmer ONLY Registration Fee-Single Meet USA Swimming Membership Fee included- - $20.00
Participant First Name
Participant Last Name
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Street Address (including Apt#)
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District of Col.
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Emergency Contact Name
Affiliated Club, Team, or Organization
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- I am not a member of a team -
Club Kick Start
Cy-Fair Swim Club
Rowan Aquatic club YMCA
TAC Titans Masters
YOTA- YMCA of the Triangle Area
new team name
Event Fees: Please select all races you plan to swim. Poseidon swimmers, please check both individual races & Poseidon
400 M Open Female - $13.00
400 M Open Male - $13.00
400 M Buddy swimmer Male or Female
5K Open Female - $13.00
5K Open Male - $13.00
3K 13/14 Female - $13.00
3K 13/14 Male - $13.00
3K Open Female - $13.00
3K Open Male - $13.00
2K 11/12 Female - $13.00
2K 11/12 Male - $13.00
2K Open Female - $13.00
2K Open Male - $13.00
800 M 10/Under Female - $13.00
800 M 10/Under Male - $13.00
800 M Open Female - $13.00
800 M Open Male - $13.00
800 M Buddy swimmer Male or Female
Poseidon Swimmer (please select if applicable in addition to specific races)
Please list middle initial
Please list your USA Club team name
Make a Donation
The Greg Doughty Building Champions Fund
, to learn more about this cause)
The Greg Doughty Building Champions Fund honors former Sandshark Greg Doughty's memory and supports Sandsharks' mission to expand aquatics programming to the Sandhills community. Through Learn to Swim lessons, competitive swimming, and lifeguard training the Sandhills Sandsharks save lives while building champions.
Make A Splash! Learn to Swim for under-served communities
, to learn more about this cause)
Sandhills Sandsharks is the only USA Swimming Make A Splash Partner in Moore County! We provide Learn to Swim lessons for at risk populations at the Town of Southern Pines Pool Park; however, we need donations to run this program; we are a nonprofit organization which receives no outside funding. In March of 2018, SSS moved its lessons and year round competitive swim program to the Town of Southern Pines pool, meaning more space for programming at a prime location in Moore County. The Southern Pines pool, built in the early 1960's, has served West Southern Pines, a predominantly African American neighborhood, for decades. It is located within blocks of both the Boys and Girls Club and elementary schools, including the soon-to-be-built K-5 elementary school off of Morganton Road. However, few of the children in the neighborhood have been able to take lessons. We are trying to change that, but need your help!
Waiver, Acknowledgement and Liability Release: I, the undersigned coach or team representative, verify that all of the swimmers and coaches listed on the enclosed entry are registered with USA Swimming. I acknowledge that I am familiar with the Safety Rules of USA Swimming, Inc. and North Carolina Swimming, Inc. regarding warm-up procedures and meet safety guidelines, and that I shall be responsible for the compliance of my swimmers with those rules during this meet. Sandhills Sandsharks, Seven Lakes Landowners, Inc, North Carolina Swimming, Inc., and USA Swimming, Inc., their agents, employees, and coaches shall be held free and harmless from any and all liabilities or claims for damages arising by reason of illness or injury to anyone during the conduct of this meet. I also acknowledge that by entering this meet, I am granting permission for the names of any or all of my team’s swimmers to be published on the internet in the form of Psych Sheets, Meet Results, or any other documents associated with the running of this meet.
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I have read and agreed to the waiver
Is the participant 18 or older?
18 or older
Parent or Legal Guardian’s Signature - By providing your electronic signature you agree that you have the authority to register these participants and agree to the waiver(s) for them as their parent or legal guardian. If registering a child under 18, you are consenting to the collection of the child's information that you are providing for the purposes of registration.
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