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Registration Form

 


SWIM TEAM REGISTRATION 2018

 

Parent/Guardian Names:

 

Address:

 

City, State, Zip

 

Are you a Newton resident?

Yes ¨

 No ¨

 If no, where do you reside?

 

Home Phone:

 

Cell Phone:

 

Additional Contact Numbers:

 

E-Mail Address (Please list all):

 

SMS #/computer provider

 

Swimmer’s Name

M/F

Age as of 7/1/18

Date of Birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Returning families:  Our family is willing to help a new family become acquainted with the swim team.

Yes ¨

No ¨

Does your child have any allergies? (if more than one child, please be specific as to each child’s allergies) If yes, please specify. 

Yes ¨

No ¨

 

 

 

 

 

 

Does your child have any medical conditions which will limit their ability to swim? If yes, please specify. 

Yes ¨

No ¨

 

 

 

 

Are child’s/children’s immunizations up to date?

Yes ¨

No ¨

Family Physician & Phone #:

 

Emergency Contact (other than parent):

 

Address:

 

Phone Numbers:

 

 

 

 

 

                                               

 

Parent/Guardian Signature: 

 

Date:

 

2018 Swim Team Fees:

¨ $100 - 1 child

¨ $175 -2 children

¨ $50 for each additional child

         

Make check out to NEWTON SWIM TEAM

Registration and fees are due by June 15, 2018. No late registrations will be accepted.

TWO VOLUNTEER forms must accompany all registrations.

 

 

MEDICAL RELEASE WAIVER: I certify that I am the parent or legal guardian for my child(ren). I hereby give my permission for any supervisor, coach or other team administrator associated with the Newton Sharks to seek and give appropriate medical attention for our child(ren) in the event of accident, injury, illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment.

I hereby waive, release and forever discharge Newton Sharks and associated supervisor, coach or other team administrator from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Newton Sharks activities, whether or not damages or loss is due to negligence. I hereby acknowledge that my children is (are) physically fit and capable of participation in all Swim Team activities.

 

Parent/Guardian Signature: 

 

Date:                                                               ________________________________________________________________________________

 

LIABILITY WAIVER: By registering my child(ren) with the Newton Sharks, I agree to participate (or allow my child(ren) and family members to participate) in the Newton Sharks, and hereby release Newton Sharks, its directors, officers, agents, coaches, and employees from liability for any injury that might occur to myself (or to my child(ren) and family members) while participating in the Newton Sharks program, including travel to and from training sessions, swim meets or other scheduled team activities.

I agree to indemnify and hold harmless the above mentioned organizations and/or individuals, their agents and/or employees, against any and all liability for personal injury, including injuries resulting in death to me, my child(ren) and/or other family members, or damage to my property, the property to my child(ren) and/or other family members, or both, while I (or my child(ren) or family members) participating in the Newton Sharks program.

 

Parent/Guardian Signature: 

 

Date:

 

 

MEDIA CONSENT AND RELEASE: The Newton Sharks has my permission to use my or my child’s photograph to promote the Newton Sharks. I understand that the images may be used in print publications, online publications, presentations, websites, and social media.

 

Photograph only                      

Yes ¨

No ¨

                                               

Photograph and identifying features including name, team, and town

Yes ¨

No ¨

 

Parent/Guardian Signature: 

 

Date:

 

 

MAIL TO: TRACY PAPARELLA, 56 HALSTED ST., NEWTON, NJ 07860

 

 

 
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