KINGSBROOKE SEA LIONS SWIM TEAM
2009 PUPS REGISTRATION FORM
Fill out the fields below to register your swimmers.   Fields marked with an asterisk (*) are required fields.
 
* New to the Kingsbrooke Swim Team?
* Parent/Guardian Name(s)
* Mailing Address
* City, State, Zip Code
* Home Phone--
Work Phone--
Cell Phone--
* Email Address(es)

For multiple email addresses, please separate with a semicolon
Emergency Contact Name
(other than parent/guardian)

Emergency Contact Phone--
Physician Name
Physician Phone--
* Insurance Carrier & Member Number
* Any Medical Conditions the coaches should know about?

Swimmer(s) Information

 
First Name
Last Name
Program *
Sex		 Date Of Birth (mm/dd/yyyy)
Age
T-Shirt Size**        
1.
2.
3.
4.
5.
* Sessions are space limited. Sessions will be filled on a first-come, first-served basis (with completed registration form and payment).
     The team scheduler will make every attempt to accommodate your requested session time.
**T-shirt sizes tend to run small. If unsure, select a larger size.
915AM / 945AM / 1015AM / 800PM Mini-Developmental sessions are FULL
700PM / 730PM Developmental sessions are FULL

Registration Fee Schedule

$90 one swimmer
$80 second swimmer = $170 total
$70 third swimmer = $240 total
$0 fourth (and any additional swimmers)
= $240 MAX TOTAL PER HOUSEHOLD
The fee includes t-shirt and a swimming medal.

Participation Agreement

Please read carefully.
I acknowledge fees are non-refundable after June 25, 2009. I agree to abide by all team and facility rules and regulations. I give my permission for my child/ren's picture to be used on the team website and/or in local team promotional publications or advertisements. I represent that my child has no life-threatening conditions. I know that swimming and water activities involve a degree of risk; by participating in the program, I accept all risks associated with the use of the facility and participation in the program. If the participant is a minor, I accept all risks on his or her behalf as parent or legal guardian. I hereby release the Kingsbrooke Sea Lions Swim Team, its Board members and agents, Armstrong Management Company, the Kingsbrooke Homeowners Association, pool committee members and independent contractors for any and all damages for personal injury arising in any way from use of the facility or participation in the program. I hereby give my permission for the swimmers listed above to be administered any and all medical attention necessary in the event of an accident, injury, sickness, etc. under the direction of his or her coaches until such time as I can be contacted. I agree to look solely to my insurance carrier to pay any damages I suffer. If the participant is a minor, I execute this release for the duration of the summer swim season on his or her behalf as his or her parent or legal guardian.

Signature
 Date
       Parent/Legal Guardian

Please print and sign/date AND mail/deliver with payment to:
Kingsbrooke Swim Team, 13480 Falcon View Ct, Bristow, VA 20136
Please make all checks payable to 'Kingsbrooke Swim Team'