SwimTeamReg-check option

Event Details

Date: June 9, 2023

Swim Team Registration Form - check 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: $50.00
Fees are due by June 9th.
Total
$0.00
Payment Options
- Check
Make check payable to: Aquatic Swim Club and mail it to: P O Box 136, Morton, PA 19070.

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Event Details

Swim Team Registration Form - check option

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