SWIMMER #1

First/Last Name

Age

Gender
---MaleFemale

Swim Experience
Level of swimming experience and any known interest/knowlege about the Nitros.

SWIMMER #2

First/Last Name

Age

Gender
---MaleFemale

Swim Experience
Level of swimming experience and any known interest/knowlege about the Nitros.

SWIMMER #3

First/Last Name

Age

Gender
---MaleFemale

Swim Experience
Level of swimming experience and any known interest/knowlege about the Nitros.

Do you wish to register more swimmers?
If yes, we will email for further details.
YesNo

FAMILY

Text Alerts Phone Number (required)

Family Email (required)

MEDICAL INFORMATION

PARENT/GUARDIAN IS RESPONSIBLE FOR NOTIFYING THE HEAD COACH OF ANY HEALTH CONCERN, INCLUDING THE SWIMMER’S USE OF MEDICATIONS, THAT MAY BE NECESSARY DURING PARTICIPATION.

WAIVER FOR PARTICIPATION

I do hereby covenant and agree that I assume all risks associated with my participation and/or listed participants in the Swim Newton Team’s authorized activity(s) and do hereby accept that any injury or injuries I may suffer from my participation and/or listed participant’s participation in the Swim Newton Team’s authorized activity shall be my own responsibility and associated with my participation and/or listed participant’s participation in a Swim Newton Team authorized activity.

Furthermore, I covenant and agree that this document shall be admissible in any court of competent jurisdiction, which adjudicates any cause of controversy existing between the Swim Newton Team and myself.

I have read and consent to the WAIVER FOR PARTICIPATION

Yes

PARENT/GUARDIAN AUTHORIZATION FOR ABOVE STATEMENTS

Parent Name

How did you hear about us (e.g. Facebook, Newspaper,
Friend, Team Promotions?