REGISTRATION FORM
Welcome Swimmers! Practices will be held at the Gilpin County Recreation Center on Mondays and Wednesdays from
5:00 to 7:00 PM. Please check the team’s website for your group’s start time.This form can be used to register all participating
swimmers in your family. In addition to this registration form, please complete the annual Release of Liability form required by
our league for EACH participating swimmer. We are happy to once again offer a multiple swimmer discount of $25 for each
additional swimmer in a family.We’re look ing forward to another great season! GO PIRANHAS!!!
Today’s Date: ________________________
Swimmer Information:
First and Last Name
T-shirt Size
Date of Birth
Swimmer #1:
/
/
Swimmer #2:
/
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Swimmer #3:
/
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Swimmer #4:
/
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Contact Information:
Home Phone:
Cell Phone:
Work Phone:
Street Address:
Zip Code
Mailing Address:
Zip Code
Mother’s Full Name:
Email Address:
Father’s Full Name:
Email Address:
Medical Insurance:
Subscriber #:
Alternate Emergency Contact:
Waiver of Liability: I represent and warrant that my child/children as listed above are in good health and have no physical
conditions, ailments, or disabilities, which could endanger my child/children’s health or safety if they w ere to participate in
vigorous physical activity. For and in consideration of the benefits derived from my child’s/children’s participation in the
Peak to Peak Swim Team program, I assume all risks and hazards incidental to such participation, including transportation to
and from such activities, and do hereby indemnify, release and hold harmless the Peak to Peak Swim Team, its officers,
directors, employees, and agents from all claims of any kind whatsoever, which may arise or hereafter accrue in connection
with the participation in the activities of the Peak to Peak Swim Team.
Consent to Participate: As Parent/Guardian of the ab ove listed minors, I grant them permission to participate in all activities
of the Peak to Peak Swim Team and by my signature hereto agree to be bound by the terms and conditions set forth in the
above paragraph.
Medical Release: I further grant permission for appropriate medical treatment to be given to my child/children as listed
above in an emergency, and will be solely responsible for any medical costs, which may arise.
Consent to Photograph: I also grant permission for Peak to Peak Swim Team to photograph my child/children at practices,
meets, and social events. The photographs may be used in our website, advertisements, press releases, posting at the pool,
etc. Peak to Peak Swim Team will not use my child’s last name in conjunction with their photograph on the webs ite.
Parent/Legal Guardian Signature:
Date:
Team Fees : The cost of this season is $100 for one swimmer and $75 for each additional swimmer in your family.
This Season’s Fees:
$100
x
First Swimmer
$ 75
x #
of Additional Swimmers
If choosing the installment option please add $5 per swimmer ($5 x
=
$ 100
=$
# of swimmers) = $
Please make check payable to: Peak to Peak Swim Team
Total Registration Fees Due = $
Swimmer’s Code of Conduct: As a swimmer on the Pea k to Peak Swim Team, I agree to adhere to the followin g behavioral
standards:
1. Teamwork and Good Sportsmanship: At all times I will be supportive and show respect to my teammates, coaches,
and competitors. At meets I will stay in the p ool until the last swimmer has completed his/her race and I will try to
shake hands with the swimmers in adjacent lanes. I will cheer on my teammates in practice and at meets.
2. Inappropriate Language: I will not use profanity or obscene gestures at any team function.
3. Safety: I will walk (not run) on the p ool deck. I will listen and obey the instru ctions of the coa ch es and lifeguards on
duty. I will not act in any way that might endanger myself or other swimmers.
Swimmer #1 Signature:
Date:
Swimmer #2 Signature:
Date:
Swimmer #3 Signature:
Date:
Swimmer #4 Signature:
Date:
Team Admini stra ti on Use Only:
Payment Received Date:
Amount: ___________Check #
Initials:
Release of Liability Received Date:
Initials:
Other notes: