SwimTeamReg-c/c optionMay 8, 2023/in Event Details Date: June 9, 2023 Swim Team Registration Form - c/c option Parent Name* First Last Cell Phone #*Email* Absence Dates 1. Child's Name First Last 1. Medical History and DOB Medical History DOB 2. Child's Name First Last 2. Medical History and DOB Medical History DOB 3. Child's Name First Last 3. Medical History and DOB Medical History DOB 4. Child's Name First Last 4. Medical History and DOB Medical History DOB Emergency Contact Information Name Last Emergency Contact Information Phone Relationship Standard Photo and Video Release Form for Minor Children I hereby authorize Aquatic Swim Club/Intra County to publish the photographs and videos taken of me and/or the undersigned minor children, and our names, for use in Aquatic Swim Club/Intra County printed publications, websites and training purposes. I release Aquatic Swim Club/Intra County from any expectation of confidentiality for the undersigned minor children and myself and attest that I am the parent or legal guardian of the children listed below and that I have the authority to authorize Aquatic Swim Club/Intra County to use their photographs, videos and names. I acknowledge that since participation in publications and websites produced by Aquatic Swim Club/Intra County is voluntary, neither the minor children nor I will receive financial compensation. I further agree that participation in any publication and website produced by Aquatic Swim Club/Intra County confers no rights of ownership whatsoever. I release Aquatic Swim Club/Intra County, its contractors and its employees from liability for any claims by me or any third party in connection with my participation or the participation of the undersigned minor children. Member's Signature* Team Fee Quantity* Price: $51.70 Quantity Fees are due by June 9th. Total $0.00 Payment Options Credit Card Credit Card pricing now includes the fees we are charged.Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name https://mspremium.s3.amazonaws.com/uploads/sites/96/2021/03/aquatic-logo.png 0 0 Toni/Carolyn https://mspremium.s3.amazonaws.com/uploads/sites/96/2021/03/aquatic-logo.png Toni/Carolyn2023-05-08 07:25:072023-05-08 07:29:47SwimTeamReg-c/c option