2009 Resident Forms

2009 DOLPHINS SWIM TEAM RESIDENT Fees and Payments** Swimmer(s) last name: __________________________

Registration Number

Fee $80.00 $80.00 $40.00 $55.00 $25.00 $3.00

st

1 Child 2nd Child Additional children Tadpoles H.S./Y.R. Water/Soda Contribution (required)

1 Grand Total

Total $ $ $ $ $ $ $

3.00

T-Shirts –Child Design (8 & under) Quantity Small

Medium

Large

Youth Adult

x-Large

Unit Cost

(N/A)

$10.00 $10.00

Grand Total

Total $ $

$

T-Shirts – Youth/Adult Design (8 & up) Quantity Small

Medium

Large

Youth Adult Grand Total

x-Large

Unit Cost

(N/A)

$10.00 $10.00

Total $ $

$

Swim Caps Quantity

Total Fees Registration T-shirts – Child T-shirts – Youth/Adult Swim Caps Total fees Paid by :

Unit Cost $10.00

Check #

Total $

$ $ $ $ $ Cash

** Includes coaches’ salaries, championship entry fees, administrative costs, team party, and trophies. Please make check payable to the Hollow @ Inwood Swim Team and return it along with this form, Registration form, the Volunteer Information Sheet, and the Parent’s Approval form. NO REFUNDS WILL BE MADE AFTER THE FIRST SWIM MEET.

2009 Hollow at Inwood Dolphins Swim Team Registration Swimmer(s) Year-round swimmer?

# Years swimming

Age as of 6-1-09

Male/Female

Date of birth

First Name

Tadpole?

Last Name

1 2 3 4 5

Address/Phone Street

Phone

E-mail

City San Antonio

State TX

Zip 78248

Parent/Guardian Information Name

Phone

Cellular

Pager

Mother Father Alternate / Emergency Contact

Medical Information Physician/Phone

Diabetic

bees

Allergy to

Asthma

Seizures

First Name

Dentist/Phone

Medications

Preferred Hospital

Allergies to medication

Other medical problems

May we print your children’s name(s), address, phone number & e-mail in a directory of the swim team to be distributed to the swim team members and coaches? _____ Yes _____ No May we use your children’s/family photographs? ___________________________ _______________________________ Parent Name (print) Signature

_____ Yes

_____ No

______________ Date

PARENT’S APPROVAL FOR PARTICIPATION IN LONE STAR SUMMER SWIM LEAGUE AND EMERGENCY MEDICAL AUTHORIZATION I hereby certify that (insert child(ren)’s name):

has my/our approval to participate in the Lone Star Swim League on the Hollow @ Inwood Dolphins Swim Team, to include practices and meets, at the Hollow @ Inwood pool or at other member team pools of the Lone Star Swim League. I/we understand and agree that the Lone Star Summer Swim League, its agents, representatives, volunteers and employees, if any, assume no responsibility or liability for any accident or injury as a result of any aspect of participation in swimming activities and swimming events. I/we hereby agree to indemnify and hold harmless the Lone Star Summer Swim League, the Hollow @ Inwood Dolphins Swim Team, their agents, employees and representatives from any and all liability for any injury to my child resulting from participation in swimming activities organized or conducted pursuant hereto. I/we understand and acknowledge that participation in the above listed activities creates the potential for receiving an injury. With the knowledge of this potential risk of injury, I/we am/are giving my son/daughter/ward permission to participate in swimming and accept full responsibility for this decision. In the event of an injury, I/we hereby grant permission to the Lone Star Summer Swim League and/or the Hollow @ Inwood Dolphins Swim Team coaching staff and/or parent volunteers to render, secure, and authorize necessary medical treatment in the event I am not immediately available to make those decisions. I/we understand that any medical expenses for injuries incurred by my/our child are my/our responsibility. My/our insurance company is ____________________________________________________________ Policy Number _____________________________ Group Number______________________________ A copy of this authorization for medical treatment shall serve as an original. ___________________________________ Parent or Guardian

______________________________________ Parent or Guardian

___________________________________ Address

______________________________________ Address

___________________________________ Home, Cell & Work Telephones

______________________________________ Home, Cell & Work Telephones

A COPY OF THIS AUTHORIZATION MUST BE IMMEDIATELY AVAILABLE AT EVERY EVENT IN WHICH THE SWIMMER PARTICIPATES.