Clinton Hills Swim Club | swim team sign-up

2021 Swim Team Registration Form

Please complete this form before May 16, 2021.

As a reminder, there is NO Suit Up this year due to Covid restrictions with our swimwear partner Swimville USA.

Parent-Guardian Name*

First Last

Parent-Guardian Address*

Street Address Address Line 2 City State ZIP Code

Parent-Guardian Phone*

Parent-Guardian Phone 2

Parent-Guardian Email*

Parent-Guardian Email 2

Swimmer Details

Swimmers

Name	Age	Level of Swimming	Actions
			Edit Delete
There are no Entries.

Maximum number of entries reached.

Emergency Medical Info

Emergency Contact*

Emergency Contact - Relationship to Swimmer*

Emergency Contact Phone*

Physician's Name

Physician's Phone

Dentist's Name

Dentist's Phone

Medical History

Please list any facts concerning your child's medical history, including allergies, medications, and any relevant problems to which a physician should be alerted.

Medical Waiver*

In the event that reasonable attempts to reach me have been unsuccessful, I hereby give my consent for (1) the administration of any treatment deemed necessary by the above named doctor or dentist, or in the event the designated preferred practitioner is not available, by another physician or dentist; and (2) the transfer of the child to any hospital reasonably accessible. This authorization does not include major surgery unless the medical opinions of two other licensed physicians or dentist, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.

I agree to the Medical Waiver

Medical Liability*

I hereby agree that the Clinton Hills Swim Club, its coaches, members, and board shall not be liable for any injury or loss that my child or children may sustain while participating in activities of any kind whether sponsored by or under the supervision of Clinton Hills Swim Team. I agree to indemnify and hold harmless Clinton Hills Swim Club and its members, coaches, and board or designates of any kind from any claim whatsoever.

I agree to the Medical Liability

Code of Conduct*

The Clinton Hills Swim Club (CHSC) Swim Team is committed to promoting and providing a safe environment for those who participate on the team. In order to assure safety and comfort for everyone, swim team members are expected to act appropriately at all times. The CHSC Swim Team Code of Conduct is not limited to the rules of the pool. The Code of Conduct includes any other inappropriate behavior including, but not limited to:

-Hazing, bullying, harassment or intimidation by words, gestures, body language,
or any other type of

-Menacing behavior;

-Verbally abusive behavior, including angry or vulgar language, swearing,
shouting, or name-calling;

-Physical contact With another person in an angry, aggressive or threatening way;

-Theft or behavior that results in the destruction or loss of property;

-Abusing alcohol or any illicit or controlled substance.

Swim team members shall display the utmost respect and sportsmanship toward coaches, Officials and fellow competitors. Swim team members are also expected to abide by the rules and regulations of other facilities while representing the Clinton Hills swim team. The coaches will handle all reported incidents of inappropriate behavior. Depending on the severity of the violation, the coaches shall enforce a sanction if deemed necessary and appropriate, including but not limited to issuing a verbal warning, sending the offending individual home for the day, or permanently removing them from the CHSC swim team. I certify I have read the CHSC Swim Team Code of Conduct and agree to abide by the Code of Conduct as set forth above and acknowledge that the failure to do so can result in my son/daughter being subject to disciplinary actions.

I agree to the code of conduct

Full Name*

Please type your full name to acknowledge and accept all aspects of this e-form.

Signature*

Registration Fee:

$55 plus 7.5% Sales Tax per swimmer.

Swimming Fees*

Price: $0.00

$55/swimmer

tax*

Price: $0.00

Total

$0.00

Option

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Name

This field is for validation purposes and should be left unchanged.