RIVERMOORE RIPTIDE
RIVERMOORE RIPTIDE 2018 Registration Form Swimmer’s Last Name Father’s Name
Mother’s Name
Address Email Home Phone
Father’s Cell
Mother’s Cell
Registration Fees Swimmer Rivermoore Park Resident Non-Resident 1st Swimmer $130 $155* nd 2 Swimmer $130 $130 rd 3 Swimmer $125 $125 th 4 + Swimmer $120 $120 Ages 15 to 18 $50 $50 Volunteer Deposit** $50 per Family – Please provide separate check *The Non-Resident fee is $25 per family Participant Information Swimmer’s Name First, Middle Initial, Last
T-shirt Size
All swimmers receive a team T-shirt if they register by 5/1/2018
Age on 6/1/18
Date of Birth [mm/dd/yy]
Male
Female
Swimmer Fee
Total Fee Paid: Check #:
Waiver I, the undersigned, do hereby consent to allow my child(ren) to participate in all the activities of the Rivermoore Park Swim Team. I assume all risks and hazards incidental to such participation and hereby waive, release, absolve, indemnify and agree to hold harmless the Rivermoore Park Swim Team, The Rivermoore Park Homeowners Association, Inc., its agents, members, homeowners, officers, board members, organizers, volunteers, coaches, and other participants.
Signature of Parent or Guardian
Printed Name
Date 2018 Application
Registration Checklist – Riptide Use Only Birth Certificate(s)? Medical Form? Concussion Waiver? Volunteer Agreement? Amount Paid
Mother’s Name
Address Email Home Phone
Father’s Cell
Mother’s Cell
Registration Fees Swimmer Rivermoore Park Resident Non-Resident 1st Swimmer $130 $155* nd 2 Swimmer $130 $130 rd 3 Swimmer $125 $125 th 4 + Swimmer $120 $120 Ages 15 to 18 $50 $50 Volunteer Deposit** $50 per Family – Please provide separate check *The Non-Resident fee is $25 per family Participant Information Swimmer’s Name First, Middle Initial, Last
T-shirt Size
All swimmers receive a team T-shirt if they register by 5/1/2018
Age on 6/1/18
Date of Birth [mm/dd/yy]
Male
Female
Swimmer Fee
Total Fee Paid: Check #:
Waiver I, the undersigned, do hereby consent to allow my child(ren) to participate in all the activities of the Rivermoore Park Swim Team. I assume all risks and hazards incidental to such participation and hereby waive, release, absolve, indemnify and agree to hold harmless the Rivermoore Park Swim Team, The Rivermoore Park Homeowners Association, Inc., its agents, members, homeowners, officers, board members, organizers, volunteers, coaches, and other participants.
Signature of Parent or Guardian
Printed Name
Date 2018 Application
Registration Checklist – Riptide Use Only Birth Certificate(s)? Medical Form? Concussion Waiver? Volunteer Agreement? Amount Paid
