Hidden Springs Swim Club Registration for 2010 is here! Contact Janet Janet Aydinova hiddenpsringssc@gmail.com for questions or additional information.
Please return this form to the green drop box hanging on the wall in the Post Office or take directly to the Town Association Office. For more updates go to the Facebook Fan Page for Hidden Springs Swim Club
Downloadable Registration Form coming soon...
Hidden Springs Swim Club 2010 Registration Form
Child’s Name (1): ____________________ Date of Birth: ____________ Age as of 5/31/010: ____
Sex: M F
Child’s Name (2): ____________________ Date of Birth: ____________ Age as of 5/31/010: ____
Sex: M F
Child’s Name (3): ____________________ Date of Birth: ____________ Age as of 5/31/010: ____
Sex: M F
Child’s Name (4): ____________________ Date of Birth: ____________ Age as of 5/31/010: ____
Sex: M F
Father’s Name: ________________________ Mother’s Name: ____________________________
Address: ______________________________________________________________________
Phone Number: __________________ Email Address: ___________________________________
Registration Fee Paid: Child (1) $________ (2) _______ (3) _______ (4) ______ Total: $________
T-Shirt Size Needed: Child (1) $________ (2) _______ (3) _______ (4) ______
Consent, Liability Waiver and Release
I, the undersigned parent/guardian of the above named child, for and on behalf of myself, my spouse, and my child hereby give my voluntary consent to permit my child to participate in the Hidden Springs Swim Club, including all practices, meets and other events, during the 2010 Hidden Springs Swim Club season. I assume all risks in any sport or swimming activity. I, for and on behalf of myself, my spouse and my child therefore release, absolve and hold harmless the Hidden Springs Swim Club and its officers, directors, coaches, instructors, volunteers and employees, from any and all claims arising out of or related to any Hidden Springs Swim Club activity, including but not limited to transportation to and from such activities, or personal injury, death, damages or any other loss, whether as a result of negligence or otherwise by the foregoing entities or individuals. I further agree to assume all risk of injury or death due to voluntary use of the Hidden Springs Town Association Inc’s facilities and to release from responsibility any person transporting my child to or from any Hidden Springs Swim Club activity.
Medical Information
Name of Physician: ____________________________ Phone Number: ___________________
Health Insurance Policy Name and Group Number: ____________________________________
Health concerns/medications: _____________________________________________________
Allergies: _____________________________________________________________________
Emergency Contact (name and number): ____________________________________________
If the hidden Springs Swim Club cannot reach me or the above named emergency contact, I give authority to any adult supervisor of the Hidden Springs Swim Club to call for, permit, and provide medical care and do hereby consent to the provisions of care to my child by medical practitioners or a hospital.
Parent/Guardian Signature: ______________________________ Date: _____________________
** Refunds will not be given after first week of practice **