Registration Fees: $40 per child $80 for two children Three or more add $35 each.

GERMANTOWN GATOR SWIM TEAM REGISTRATION FORM

last updated 3/14

Board Use Only: Reg. Cash____ Check#______ Work Dep. Check#______ Check#______

FIND US ON FACEBOOK: GERMANTOWN GATORS Swimmers will not be permitted to practice with the team until all paperwork and payments, including pool pass, are received. There will be a

$10 LATE REGISTRATION FEE PER SWIMMER

for any paperwork or payments received after May 23, 2014 Swimmers Name_______________________________ Age as of 6/1___________ Address___________________________________________________Phone_________________ ___________________________________________________ Date of Birth___________________ Sex: Male or Female
Parents or Guardians *****Circle preferred number for phone notification system (One Call Now)*****

1._______________________Phone: HM______________WK______________ CELL________________ 2._______________________Phone: HM______________WK______________ CELL________________ Other/Guardian if applicable_______________ HM____________WK______________CELL___________

E-mail address (for weekly newsletters and updates)__________________________________________________________

Please check if you do NOT approve photos of your child being used for Gator publicity (e.g. website).

I understand that I am required to pay a $100 work deposit. This SEPARATE check will be returned at the end of the season after it has been determined that I completed the work schedule requirements of 6 sessions plus Championships for a total of 7 sessions. One session = a meet. Parent Signature______________________________________________________

******CONTINUED ON BACK******

HEALTH AND EMERGENCY INFORMATION Height ____________Weight ______________General Health__________________ History of: Heart Trouble_________Asthma___________Diabetes_________Epilepsy________
PLEASE USE AN ADDTL SHEET IF NECESSARY TO MAKE NOTES OF IMPORTANCE TO THE COACHES

Allergic to: Food ____________________Medication _________________Other_______________ What reaction does the swimmer have? ________________________________________________ Does the swimmer carry an inhaler or kit? ___________________ Is the swimmer taking any medications on a regular basis? ___________ If yes, please identify medications(s):__________________________________________

I hereby give my consent for the above named individual to engage in the GERMANTOWN SWIM TEAM program. I also give my consent for the above named swimmer to be transported by the coach, adult chaperone, or the emergency squad, in the event of an accident, to the nearest medical facility for treatment. My preferred hospital care facility is __________________________________________ Childs doctor/pediatrician is:___________________________________ _____________ Childs dentist is: _________________________________________________________ EMERGENCY PHONE NUMBERS In case of an emergency, you should call these people in my/our absence. Name__________________________PH#______________________Relationship_______________ ___________________________PH# ______________________Relationship_______________ GERMANTOWN GATORS LIABILITY RELEASE
Swimmers name______________________________________________________
I, the undersigned (if applicant/participant is 18 years of age or older) or the parent/guardian of the above listed minor applicant/participant acknowledge and fully understand that each applicant/participant will be engaging in activities that involve risk of injury which might result not only from their own actions, inaction or negligence, but there may be other unknown risks not reasonably foreseeable at this time, assume all the forgoing risk and accept personal responsibility for the damages following such injury, hereby release, discharge, covenants to indemnify and not sue Germantown Gator Swim Team, Germantown gator Board Members, Germantown Gator Swim Pool Board all of which are hereafter referred to as releases, from any and all liability to each of the undersigned, his/her heirs or next of kin for any all against claim by or on the behalf of the applicant as a result of the applicants participation in the Programs and/or being transported to or from the same, which participation, after careful consideration I hereby authorize. I hereby give my consent to have a coach, and/or a doctor of medicine, dentistry, or associated personnel to provide medical treatment. I also agree to save and hold harmless and indemnify each and all parties herein referred to above releases from all liability, loss, cost, claim or damage whatsoever, including death or damage to property, which may be imposed upon said release because of any defect in or lack of such capacity to so act or caused to alleged to be caused in whole or in part by the negligence of the release. I have read the above waiver/release and understand that (I) we have given up substantial rights by signing this release and sign below voluntarily.

Parent Signature_____________________________________Date____________________