Swim with A.R.T for one week at no charge
and we think you'll want to join our swim team!!!
Swimmer's Name ______________________ DOB _____
Swim with A.R.T.M for one week at no charge
Swimmer's Name ______________________ DOB _____
Parent's Names ________________________________
Address _______________________________________
City ____________________ State _____ Zip _____
Phone: (h) _________ (W) _________ (c) ________
E-Mail: _______________________________________
Start Date ____________________________________
Swimmer's 2 Name ____________________ DOB _____
Swimmer's 3 Name ____________________ DOB _____
I give my Permission for
_______________________________________________
To Participate In The Augusta Rip Tides Swim
Team ONE WEEK TRIAL Program.
RELEASE AND INDEMNIFICATION:
I agree to and hereby release Augusta Rip Tides coaching staff;
Augusta-Richmond County; Georgia Swimming,Inc.; and USA
Swimming,Inc.; their agents and employees from all liabilities
and claims arising by reason of injuries that may occur to my
child while participating in the programs of the A.R.T. Swim
Team, including travel to and from training sessions,other
scheduled activities, and swimming meets. I agree to indemnify
and hold harmless the above mentioned,their agents and
employees, against any and all liability for personal injury,
including injuries resulting in death, or damage to property,
or both, while enrolled in the program. I agree to reimburse
the above for any and all damages they are compelled to pay
arising from any such claim, demand, action, or cause of
action as may arise from my child or my child's action while
enrolled in the program.Signature of
Parent/Guardian:___________________________________________Date:_______________
AUGUSTA RIP TIDES SWIM TEAM REGISTRATION/RELEASE
AGE GROUP
SWIMMERS FULL NAME:___________________________________________
SWIMMERS PREFERED NAME:_______________________________________
AGE: _____ DATE OF BIRTH: ___________________________________
ADDRESS:______________________________________________________
(street) (city) (state) (zip)
HOME PHONE: ____________ CELL PHONE: _________________________
SWIMMERS' EMAIL: _____________________________________________
PARENTS' EMAIL: ______________________________________________
PARENTS'NAMES: _______________________________________________
HOME PHONE & ADDRESS: ________________________________________
(if different from swimmer's)
PERSON TO NOTIFY IF PARENT/GUARDIAN IS UNAVAILABLE: __________
PHONE NUMBER: _________________ CELL PHONE: __________________
PROFESSION: __________________________________________________
PLACE OF EMPLOYMENT: _________________________________________
BUSINESS PHONE: ______________________________________________
MEDICAL INSURANCE CO.: _______________________________________
POLICY HOLDER:___________________ POLICY #: __________________
Are there any health or learning factors which the coaching
staff should be aware of? yes or no
If yes, please explain:_______________________________________
Are there any physical limitations that may affect a swimmer's
normal swimming routine? yes or no
If yes, please explain:_______________________________________
Will your swimmer require any special accomodations in order
to participate in this program? yes or no
If yes, please explain:________________________________________
Please list any other extra activities that may conflict with
the team and practice schedule:________________________________
_______________________________________________________________
LAST USAS TEAM:___________________ DATE SEPARATED:_____________
RELEASE AND INDEMNIFICATION:
I agree to and hereby release Augusta Rip Tides coaching staff;
Augusta-Richmond County; Georgia Swimming,Inc.; and USA
Swimming,Inc.; their agents and employees from all liabilities
and claims arising by reason of injuries that may occur to my
child while participating in the programs of the A.R.T. Swim
Team, including travel to and from training sessions,other
scheduled activities, and swimming meets. I agree to indemnify
and hold harmless the above mentioned,their agents and
employees, against any and all liability for personal injury,
including injuries resulting in death, or damage to property,
or both, while enrolled in the program. I agree to reimburse
the above for any and all damages they are compelled to pay
arising from any such claim, demand, action, or cause of
action as may arise from my child or my child's action while
enrolled in the program.Signature of
Parent/Guardian:___________________________________________Date:_______________
MEDICAL CARE AUTHORIZATION FORM
AGE GROUP
Swimmer's Name _________________________________________________
Age _______ Birthday____________________________________________
Address __________________ Home Phone __________________________
City _________________ State _____ Zip ________________________
Significant Medical History(allergies,injuries,
surgeries): ____________________________________________________
________________________________________________________________
Medications Currently Being Used:_______________________________
________________________________________________________________
Medical Insurance Coverage______________________________________
Policy Holder:_______________ Policy #: ________________________
Personal Physician:_______________ Phone #:______________________
Dentist:__________________________ Phone #:______________________
Other:____________________________ Phone #:______________________
_________________________________________________________________
TO WHOM IT MAY CONCERN:
We hereby give full power of atorney to the Augusta
Rip Tides coaching staff, team chaperones, or Augusta
Rip Tides employees to authorize and contract for such
medical or dental care as deemed necessary
for _____________________________(name) by a physician or
dentist. Any such authorization and contact shall be
on our behalf and in our name and stead.
Parents' Name:________________ ________________________________________
Home Phone: ________________ Business Phone: __________________________
Cell Phone: __________________ ________________________________________
Signature: ___________________ ________________________________________
Date: ________________________ _________________________________________
Release and Indemnification
By registering my child(ren), ___________________________________________
with the Augusta Rip Tides Swim Team, I give my
consent for my child(ren) to participate in all the
activities of the Augusta Rip Tides Swim Team.
I understand that some activities of the Augusta Rip
Tides Swim Team may be the subject of liability
insurance protection but that some activities may not
be protected by liability insurance. There-fore, in
consideration of the benefits to me from the
participation by my child(ren) in the activities of
the A.R.T. Swim Team,and other good and valuable
consideration, the undersigned hereby releases Augusta
Rip Tides Swim Team, it's owners, agents,coaches and
employees,(hereinafter referred to as "A.R.T.") from
any and all claims whatsoever made by any person or
entity against Augusta Rip Tides arising out of the
participation by my child(ren) in functions of A.R.T.
swim team including, but not limited to,travel to and
from A.R.T. swim team functions. The undersigned
further agrees to indemnify, defend and forever hold
Augusta Rip Tides Swim Team harmless from any and all
claims (including any cost of defending claims)
whatsoever made by any person or entity arising out
of the participation by my child(ren) in functions of
the Augusta Rip Tides Swim Team.
Date:________ Parent/Guaridian: __________________________________________
Sworn to and subscribed
before me on the____ day of______,Yr._____________________________________
Notary Public_____________________________________________________________
My commission expires_____________________________________________________
FREE ONE WEEK TRIAL REGISTRATION
MASTERS
and we think you'll want to join our swim team!!!
Address _______________________________________
City ____________________ State _____ Zip _____
Phone: (h) _________ (W) _________ (c) ________
E-Mail: _______________________________________
Start Date ____________________________________
Signature
_______________________________________________
To Participate In The Augusta Rip Tides Swim
Team ONE WEEK TRIAL Program.
_______________________________________________
Date
RELEASE AND INDEMNIFICATION:
I agree to and hereby release Augusta Rip Tides coaching staff;
Augusta-Richmond County; Georgia Swimming,Inc.; and USMS
Swimming,Inc.; their agents and employees from all liabilities
and claims arising by reason of injuries that may occur to me while participating in the programs of the A.R.T.M. Swim
Team, including travel to and from training sessions,other
scheduled activities, and swimming meets. I agree to indemnify
and hold harmless the above mentioned,their agents and
employees, against any and all liability for personal injury,
including injuries resulting in death, or damage to property,
or both, while enrolled in the program. I agree to reimburse
the above for any and all damages they are compelled to pay
arising from any such claim, demand, action, or cause of
action as may arise from my action while
enrolled in the program. Signature:___________________________________________Date:_______________
AUGUSTA RIP TIDES SWIM TEAM REGISTRATION/RELEASE
MASTERS
SWIMMERS FULL NAME:___________________________________________
SWIMMERS PREFERED NAME:_______________________________________
AGE: _____ DATE OF BIRTH: ___________________________________
ADDRESS:______________________________________________________
(street) (city) (state) (zip)
HOME PHONE: ____________ CELL PHONE: _________________________
SWIMMERS' EMAIL: _____________________________________________
PERSON TO NOTIFY IN CASE OF EMERGENCY: __________
PHONE NUMBER: _________________ CELL PHONE: __________________
PROFESSION: __________________________________________________
PLACE OF EMPLOYMENT: _________________________________________
BUSINESS PHONE: ______________________________________________
MEDICAL INSURANCE CO.: _______________________________________
POLICY HOLDER:___________________ POLICY #: __________________
Are there any health or learning factors which the coaching
staff should be aware of? yes or no
If yes, please explain:_______________________________________
Are there any physical limitations that may affect your
normal swimming routine? yes or no
If yes, please explain:_______________________________________
Will you require any special accomodations in order
to participate in this program? yes or no
If yes, please explain:________________________________________
Please list any other extra activities that may conflict with
the team and practice schedule:________________________________
_______________________________________________________________
LAST USMS TEAM:___________________ DATE SEPARATED:_____________
RELEASE AND INDEMNIFICATION:
I agree to and hereby release Augusta Rip Tides coaching staff;
Augusta-Richmond County; Georgia Swimming,Inc.; and USMS
Swimming,Inc.; their agents and employees from all liabilities
and claims arising by reason of injuries that may occur to me while participating in the programs of the A.R.T.M. Swim
Team, including travel to and from training sessions,other
scheduled activities, and swimming meets. I agree to indemnify
and hold harmless the above mentioned,their agents and
employees, against any and all liability for personal injury,
including injuries resulting in death, or damage to property,
or both, while enrolled in the program. I agree to reimburse
the above for any and all damages they are compelled to pay
arising from any such claim, demand, action, or cause of
action as may arise from my action while
enrolled in the program. Signature:___________________________________________Date:_______________
MEDICAL CARE AUTHORIZATION FORM
MASTERS
Swimmer's Name _________________________________________________
Age _______ Birthday____________________________________________
Address __________________ Home Phone __________________________
City _________________ State _____ Zip ________________________
Significant Medical History(allergies,injuries,
surgeries): ____________________________________________________
________________________________________________________________
Medications Currently Being Used:_______________________________
________________________________________________________________
Medical Insurance Coverage______________________________________
Policy Holder:_______________ Policy #: ________________________
Personal Physician:_______________ Phone #:______________________
Dentist:__________________________ Phone #:______________________
Other:____________________________ Phone #:______________________
_________________________________________________________________
TO WHOM IT MAY CONCERN:
We hereby give full power of atorney to the Augusta
Rip Tides coaching staff, team chaperones, or Augusta
Rip Tides employees to authorize and contract for such
medical or dental care as deemed necessary
for _____________________________(name) by a physician or
dentist. Any such authorization and contact shall be
on our behalf and in our name and stead.
Person To Notify In Case Of Emergency:_________________________________
Home Phone: ________________ Business Phone: __________________________
Cell Phone: __________________________________________________________
Signature: ___________________________________________________________
Date: _________________________________________________________________
Release and Indemnification
By registering (Name), ___________________________________________
with the Augusta Rip Tides Swim Team, I
consent to participate in all the
activities of the Augusta Rip Tides Swim Team.
I understand that some activities of the Augusta Rip
Tides Swim Team may be the subject of liability
insurance protection but that some activities may not
be protected by liability insurance. There-fore, in
consideration of the benefits to me from the
participation by me in the activities of
the A.R.T.M. Swim Team,and other good and valuable
consideration, the undersigned hereby releases Augusta
Rip Tides Swim Team, it's owners, agents,coaches and
employees,(hereinafter referred to as "A.R.T.M.") from
any and all claims whatsoever made by any person or
entity against Augusta Rip Tides arising out of the
participation by me in functions of A.R.T.M.
swim team including, but not limited to,travel to and
from A.R.T.M. swim team functions. The undersigned
further agrees to indemnify, defend and forever hold
Augusta Rip Tides Swim Team harmless from any and all
claims (including any cost of defending claims)
whatsoever made by any person or entity arising out
of the participation by me in functions of
the Augusta Rip Tides Swim Team.
Date:________ Signature: __________________________________________
Sworn to and subscribed
before me on the____ day of______,Yr._____________________________________
Notary Public_____________________________________________________________
My commission expires_____________________________________________________