Practice Group__________________

Amount received with Application $_________

 CARMEL SWIM CLUB

2007-2008 REGISTRATION APPLICATION

Check One:              New Registration   ______     or Current Member    ______         Date_________________________

SWIMMER's

FULL NAME______________________________________________________________________________________

                                              LAST                                        FIRST                                  MIDDLE

SWIMMER’S PREFERRED FIRST NAME______________________________

T-SHIRT SIZE_______________________________ SWEAT SHIRT SIZE_________________________________

AGE________________ BIRTHDAY ________/_________/_________SEX_____________________________

ADDRESS _________________________________________________CITY_________________________________________

STATE__________________ ZIP__________-_______HOME PHONE ________________________________ 

SCHOOL________________________________________________________      GRADE____________________

T-SHIRT SIZE__________________________________________ SWEAT SHIRT SIZE__________________________________

(shirt sizes used for Awards/State shirts through July 2005)

PARENT’S EMAIL ADDRESS____________________________________________________________________

(Information is send to this address on a regular basis)

SWIMMER’S EMAIL ADDRESS__________________________________________

FATHER’S NAME__________________________________________________________________________

FATHER'S ADDRESS (IF DIFFERENT FROM ABOVE)

_________________________________________________________________________________________

FATHER'S EMPLOYER _______________________________________PHONE _______________________

MOTHER'S NAME _________________________________________________________________________

MOTHER'S ADDRESS (IF DIFFERENT FROM ABOVE) ___________________________________________

MOTHER'S EMPLOYER______________________________________PHONE ________________________

FINANCIAL INFORMATION 

WHO IS RESPONSIBLE FOR PAYMENT OF DUES _______________________________________________

ADDRESS OF RESPONSIBLE PARTY _________________________________________________________

CITY __________________________________ STATE________ZIP____________ PHONE ______________

RELATIONSHIP OF RESPONSIBLE PARTY TO SWIMMER

__________________________________________________________________________________________

AUTHORIZATION

I hereby give consent for my child(ren) to participate with Carmel Swim Club, Inc.  In consideration of being permitted to participate as a member of the Carmel Swim Club swim team, I hereby release, discharge and agree to hold harmless the Carmel Swim Club, Inc., and it’s coaches, members of the Board of Directors, it’s volunteers, it’s agents and it’s employees, together with it’s successors and assigns, from any and all liability for injuries to property or person suffered as a result of participation as a member of the Carmel Swim Club.  I give the club authorization to apply for United States Swimming memberships for my child(ren).

I agree that it is the swimmers’, their parents/guardians’, or designated representatives responsibility to provide transportation to, from and during any program of the Carmel Swim Club and that any transportation provided by representatives of Carmel Swim Club, Inc. is not being provided on behalf of Carmel Swim Club, Inc., and is strictly voluntary on the part of the person providing that transportation.

I agree to and will sign the following:  “Terms and Conditions for Participation in the Carmel Swim Club” on the reverse side of this form, “Medical Release”, “Honor Code” (return one for each swimming), and “Swim Meet Contract”.  I also have read and understand the “2004/2005 Fee Structure”.  I understand that all these forms constitute a legally binding contract.

_____________________________________________/________________________________        ____________________

              SIGNATURE                                               RELATIONSHIP TO SWIMMER                         DATE

__________________________________________________________________     ___________________

    SIGNATURE OF PARTY RESPONSIBLE FOR DUES                                                 DATE

APPLICATIONS CANNOT BE ACCEPTED WITHOUT BOTH APPLICABLE SIGNATURES

NEW APPLICANTS-PLEASE COMPLETE THIS SECTION

HIGH SCHOOL TEAM                            Y OR N                    IF YES, TEAM _________________________________

SUMMER SWIM TEAM                           Y OR N                    IF YES, TEAM _________________________________

USA SWIM TEAM                                  Y OR N                    IF YES, TEAM _________________________________

DATE OF LAST USA COMPETITION?                  ______________________________________________________

BEST TIMES: PLEASE SPECIFY SHORT COURSE YARDS, SHORT COURSE METERS, LONG COURSE METERS

FREESTYLE   50______ 100______ 200______ 400/500 ________800/1000________1650/1500 ___________

BACKSTROKE 50______ 100________ 200__________     BREAST   50 _______ 100________ 200________

BUTTERFLY  50 _______100 ________200_________        I.M.  100________ 200 _________  400 __________