Minnewaska Swimmers

MDSA Application Form

For MDSA Use to initial at the Test on: ____________________ (date)
Risk/Release Signed	Paid	Passed Test	Card & New Member Letter

Applications can only be submitted from April 1st through August 31st for the current swim season.

First Name *

Last Name *

Mailing Address *

City *

State *

Zip OR Foreign *

Email *

Primary Phone *

Secondary Phone

Emergency Contact *

Emergency Phone *

VOLUNTEER OPPORTUNITIES: We cannot maintain this organization and our minimal membership fee without help from our members. Please consider where you could volunteer. Whatever time you have would be appreciated.

I would like to volunteer for Computer Assistance
Clerical Assistance
Swim Testing
Volunteer Guide
On a nice weekend it is often difficult to get into the park after 11AM without a long wait. Our Volunteer Guides are allowed immediate entry so they can get to their shifts on time. Accounting Assistance
Other – Please specify →

Create Password *

Repeat Password *

MDSA is on facebook: Unless you are sure you'll have a regular swimming companion who is also an MDSA member, request to join our faceook group at "Minnewaska Distance Swimmers Association" where e.g. you can also exchange information regarding swimming or housing exchanges.

THE NEW YORK STATE OFFICE OF PARKS, RECREATION, AND HISTORIC PRESERVATION NEW MEMBER ACKNOWLEDGMENT OF RISK AND RELEASE

I affirm that I am a competent swimmer, am in good health, and I am over the age of eighteen. I understand that swimming, especially in unguarded areas, because of its nature, carries with it a possibility of personal injury and possibly death to myself, other participants, and third parties. I understand that in case of emergency lifeguards will not be available to assist in a timely fashion. I acknowledge that the Office of Parks, Recreation and Historic Preservation and the Palisades Interstate Park Commission agree to permit me to engage in this activity on State lands only upon my assumption of responsibility for any injury to myself, other participants, or third parties which may result from engaging in this activity.

Therefore, in consideration of the State permitting me to utilize the "family beach" at Lake Minnewaska to engage in unguarded lap swimming, I hereby assume all risks involved in said activity and forever discharge, release and absolve the State of New York, the New York State Office of Parks, Recreation and Historic Preservation, the Palisades Interstate Park Commission, the Minnewaska Distance Swimmers Association (MDSA), and its officers, agents, employees from any and all liability for damage or personal injury, including death, which may result from my participation in lap swimming in an unguarded area. I furthermore agree to defend, indemnify and keep harmless the People of the State of New York, the Office of Parks, Recreation and Historic Preservation, the Palisades Interstate Park Commission, the MDSA, its commissioners, officers, agents and employees from all claims, suits, actions, damages and costs of every nature and description which might result from the conduct of activities under this permit. This release shall be binding upon my executors, administrators, next of kin and assigns.

In addition, I acknowledge that the Vehicle Use Fee paid was for the use of the roadways and parking lot in the park and is not a fee to engage in any recreational activity, including the activities covered under the permit.

I agree to the terms of service *

Add 5 and 6:

BEFORE submitting this application (you MUST click on Apply for Membership button below) be sure to PRINT IT. Bring the printout to a swim test along with two head shot photos (1X1-1/4"), $25 (cash or check), and a signed copy of the NYS Release (PDF).

Print this Form