KINGSBROOKE SEA LIONS SWIM TEAM
2009 SUMMER SEASON
REGISTRATION FORM

Fill out the fields below to register your swimmers.   Fields marked with an asterisk (*) are required fields.
* New to the Kingsbrooke Summer 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 Sex Date Of Birth
(mm/dd/yyyy)
 Age*
(as of 6/1/09)
 T-Shirt Size**        
1.
2.
3.
4.
5.
* PWSL Summer Swim policy states the age of your child on June 1, 2009 determines the age group they swim for the entire summer.
    For example, if your child is 8 on June 1st, even if they turn 9 on June 2nd, they will swim as an 8 and under for the summer. Same for all ages. Thanks!
** T-shirt sizes tend to run small. If unsure, select a larger size.

Registration Fee Schedule

Kingsbrooke ResidentsNon-Kingsbrooke Residents
$100 one swimmer$115 one swimmer
$90 second swimmer = $190 total$105 second swimmer = $220 total
$80 third swimmer = $270 total$90 third swimmer = $310 total
$0 fourth (and any additional swimmers)
= $270 MAX TOTAL PER HOUSEHOLD 		$0 fourth (and any additional swimmers)
= $310 MAX TOTAL PER HOUSEHOLD
The fee includes silicone swim cap, t-shirt, and a trophy. Team competition suit is NOT included in the fee.
LATE REGISTRATION: After May 6, 2009 please add $15 per swimmer

Parent Volunteering

Parent volunteers are essential to the operation of any swim team. Please select areas of interest you have for volunteering for the summer. click here for volunteer position descriptions
 
* First Choice: Second Choice: Third Choice:

Please indicate is more than one parent/guardian is available to volunteer:   
Note: Positions with two asterisks** require PWSL officials training (free of charge) held at Bristow Run Elementary School (see website for details)

Participation Agreement

Please read carefully.
I acknowledge fees are non-refundable after June 1, 2009. I agree to abide by all swim 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'