Registration
Event:
Start Date/Time:
End Date/Time:
Fee per Family:
Room:
*
- denotes required fields
Family Information
First Name:
*
Last Name:
*
Type
*
Caregiver
Father
Guardian
Mother
Parent
Self
Home Phone:
Cell #:
Work #:
Email:
(Emails are kept confidential)
Address:
*
City:
*
State:
*
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NE
NC
ND
NH
NJ
NM
NY
NV
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip:
*
Add New Student #1:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Skill Level (1-7 See Website):
*
Add New Student #2:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Skill Level (1-7 See Website):
*
Add New Student #3:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Skill Level (1-7 See Website):
*
Add New Student #4:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Skill Level (1-7 See Website):
*
Add New Student #5:
(Show-Hide Details)
Student's First Name:
*
Last Name:
*
Student Gender:
*
Female
Male
Birth Date:
*
(format=mm/dd/yyyy)
Skill Level (1-7 See Website):
*
Questions/Options:
Participant Number 1: Name / Special Needs
*
Participant Number 2: Name / Special Needs
Additional Information:
Waiver
(Show-Hide Details)
I am the parent/guardian of the participant(s) identified herein and enrolled in a swimming program with Crawfish Aquatics. I acknowledge and understand that swimming is a hazardous activity and that there are risks inherent in the sport of swimming, including but not limited to drowning, fatigue, paralyzing injury and death.
I acknowledge that the participant(s) may participate in swimming activities at Crawfish Aquatics. I hereby agree to indemnify and hold harmless Crawfish Aquatics, its management, directors and agents, members, associates and employees against any and all liability for any injury that may occur to the participant(s) while present at Crawfish Aquatics or participating in a swimming program, regardless of the cause of the injury or damage. I also hereby agree to indemnify Crawfish Aquatics, its management, directors and agents, members, associates and employees against any damages arising from any injury, property damage, claim, demand, action or cause of action by or on behalf of the participant(s) while on the premises of Crawfish, regardless of the cause of the injury or damage.
I agree to and hereby authorize any representative of Crawfish Aquatics to have the participant(s) treated in the event of any medical emergency which may arise and will pay all costs associated with any medical care and transportation for the participant(s).
I've read the above and agree.
Enter your Full Name:
*
Other Questions/Comments:
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