YOUR REFUGE FROM THE BUSTLE OF DAILY LIFE!


THE MEDICAL RELEASE FORM IS TO BE FILLED OUT AND TURNED IN TO YOUR SWIMMER’S COACH.



RELEASE FROM LIABILITY AND INDEMNIFICATION: I agree to waive and release the Edenwood Swim  Club and Edenwood Swim Team, and its officers, agents, and employees from and against any and all claims, cost liabilities, expenses, or judgments, including attorney’s fees and court costs arising from my or  my child/ren`s participation in the City’s recreation program or an illness or injury resulting there from and  against any and all such claims, whether caused by negligence or otherwise, except for illness and injury  resulting directly from gross negligence willful misconduct on the part of the City , Swim Team or its  employees. I understand that if I am or my child/ren is/are injured this waiver will be used against me and  anyone else claiming damage because of my or my child/ren`s injury in any legal action. I hereby represent  that I understand and am familiar with the nature of the activities in which I or my child/ren will participate in  this recreational program, that I am or my child/ren is/are in good physical health, and that I or my child/ren  do not have physical or emotional conditions, past or present, of which I am aware, which would any way  affect my or my child/ren`s ability to participate in this activity. I have read and understand this waiver and  the dues structure and policies.



________________________________________                                                              ______/__              ______________________________   ____________________                                                                

  SIGNATURE                                RELATIONSHIP TO SWIMMER           DATE



MEDICAL AUTHORIZATION:  Pursuant to Civil Code 25.8, the parent/guardian authorizes to any coach or officer of the Edenwood Swim Team to arrange for medical and dental care of_______________________, and give oral or written consent on my behalf for medical and dental treatment including surgery by a licensed physician.  The parent/guardian agrees to be responsible for all such charges.

Parent signature:                                                        Date:



Name (first Middle Last):                            Birthday:                                  


Street:                                                                                                     



City:                                          Zip:                                 




Father’s name:                                                                                Email address:                                                                  


Home phone:                                 Work phone:                                 Cell phone:                                 


Mother’s name:                                                                                Email address:                                 




Home phone:                                           Work phone:                                                 Cell phone:                                 


PERSON TO NOTIFY IN CASE OF AN EMERGENCY:


1.                                                                              Phone:                                 



2.                                                                              Phone:                                 



Physician                                                                          Phone:                                  



Please make note of any special information (i.e. allergies, chronic illness, allergies to medicine, etc.) which might affect participation of your children in this program:



  



                                Edenwood Swim Club and Swim Team

Swimmers Name(s)                               Date of Birth             Age as of 6/1/2017

__________________________________         ___________________                _____________

__________________________________         ___________________                _____________

__________________________________         ___________________                _____________

__________________________________         ___________________                _____________

Parent(s)_________________________________Address_________________________________

City___________________ Cell Phone________________   Home Phone_________________

Email _______________________________________

Edenwood Swim Club Member    Y       or        N

First Time Family Membership Pricing Available for $375 – Fill out Edenwood

Swim Club Application


Non-Member Pool Fee   ________    $175.00 (Edenwood Swim Team)

Registration Fee                         Swim Suits (Male $39 or Female $59)

1st Swimmer   $35.00    ________ Suit Size M______ F________ $_________

2nd Swimmer   $20.00    ________ Suit Size M______ F________ $_________

3rd Swimmer   $20.00    ________ Suit Size M_______F________ $ ________

4th Swimmer   $20.00    _________Suit Size M______F_________ $_________

Total Registration $ ____________              Total Swim Suits $_________

T-Shirt Size(s) ________________________________$10 each   Total t-shirts $________


Cap(s) _________________$5 each                                        Total caps     $________

         

Total (non-member pool fee or family pool membership, registration, swim suits,

t-shirts, and caps)

           Cash ___________        Check No.____________    Total $_________________