Member Number

Child's First Name

Child's Last Name

Birthday Date

YYYY

Gender

LESSONS

(COACHES WILL DETERMINE APPROPRIATE CLASS BY ABILITY)

Diving Lessons

Yes

Swimming Lessons

Yes

Age 15 & Older

(Must be 15 on or before June 15 -Does not take lessons)

Yes

TEAM REGISTRATION

Pre-Team

Yes

Diving Team

Yes

Swim Team

Yes

Water Polo

Yes

Synchro

Yes

Scheduling Conflicts

(Let us know of any potential conflicts with lessons or practices)

Select

Will this child be participating in any of the RPC sailing programs?

Extended Absences

(Please list any extended absences: summer school, camp, family vacations etc.)

CONTACT INFORMATION

(ONLY NEEDS TO BE FILLED OUT ONCE PER FAMILY)

Parents Name

First Name

Last Name

Primary Email

Additional Email 1

Include additional emails you would like aquatics updates to be delivered.

Additional Email 2

Include additional emails you would like aquatics updates to be delivered.

Primary Cell Phone

(###)

###

####

Additional Cell Phone

(###)

###

####

Emergency Contact Name

First Name

Last Name

Emergency Contact Cell

(###)

###

####

PHOTO PUBLICATION CONSENT

I HEREBY GIVE PERMISSION TO THE ROCKY POINT CLUB TO POST PHOTOS TAKEN OF MY CHILD TO THE RPC PHOTO SHARING SITE OR BULLETIN BOARD LOCATED AT ROCKY POINT. THE ROCKY POINT PHOTO SITE IS EXCLUSIVELY USED BY RPC MEMBERS AND IS PASSWORD PROTECTED. THESE PHOTOS WILL NOT BE USED FOR COMMERCIAL PURPOSES.

Photo Consent

Yes

LIABILITY AND MEDICAL RELEASE

I (we) the undersigned parent, parents or guardian of child named above, a minor, understand that participation in the Rocky Point aquatics program is entirely at their own risk and that neither the Rocky Point Club Aquatics staff, Rocky Point Club, its Officers and Board of Governors chaperones, sponsors nor the organizing bodies or committees or individuals appointed or volunteering accept any liability for damages to property or personal injuries sustained during this program, and do hereby authorize and consent to any X-ray, examination, anesthetic, medical or surgical diagnosis rendered under the general or special supervision of any member of the medical/dental profession licensed under applicable law or on the staff of any acute general hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power to render care which the aforementioned physician in the exercise of his best judgment may deem advisable. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the patient, but that any of the above treatment will not be withheld if the undersigned cannot be reached.

Digital Signature of Parent or Guardian

Relationship

Date of Release

YYYY

Thank you!

Please remember to submit a form for each participant.

Click here to return to the registration form

AQUATICS REGISTRATION FORM

Please complete form below for each participant in the aquatics program.