GreenWaveAquatics.com
Empowering swimmers to be lifetime champions in and out of the water
TEAM REGISTRATION FORM
Parent
First and Last Name
Information
Mother
Address
Cell & Work phone
Email
Father
Emergency
Contact
Swimmer
Information
First and Last
Name
Date of
Birth
Age of
6/1/2015
Sex
Grade
Completed
6/1/2015
Medical
Conditions
Allergies
Swimmer
Swimmer
Medical
Information
Doctor
Number
Dentist
Phone Number
Insurance
Information
Insurance
Company
Name
Policy Number
Person Insured
I certify that the above_____(# of swimmers registered) named candidate(s) are in good health and have no impairments or physical conditions which
would endanger his/her/their well-being by participating in the Green Wave Aquatics (“GWA") activities. As the parent/legal guardian of the above
named swimmer(s), I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This
care may be given under whatever conditions are necessary to preserve the life, limbs, or well-being of my dependent(s). I also, grant my permission
that the named swimmer(s) may be transported to the appropriate medical facility for treatment. Initials__________
Furthermore, I the parent/guardian of the above ______ (# of swimmers registered) registrant(s), minor(s), agree that I and the registrants will abide by
the rules of GWA, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with swim team events and in
consideration for GWA accepting the registrant(s) for its swim team programs and activities (the "Programs"), I hereby release, discharge and/or
otherwise indemnify GWA, its affiliated organizations, Board of Directors and sponsors, their employees, and associated personnel and volunteers,
including the owners of pools and facilities utilized for the Programs, against any claims by or on behalf of the registrant(s) as a result of the registrants'
participation in the Programs and/or being transported to or from the same, which transportation I do hereby authorize. Initials___________
Photo Release: I give permission for GWA to take photos of the above______ (# of swimmers registered) for publicity purposes. I understand that said
photos may be published in local newspapers, publications, website, etc. Initials___________
PARENT/LEGAL GUARDIAN
SWIMMER WHO IS/WILL BE AGE 18 OR OLDER
PRINT NAME ______________________________________________ PRINT NAME___________________________________________________
SIGNATURE DATE _________________________________________ SIGNATURE DATE _____________________________________________