rivermoore riptide – junior riptide

RIVERMOORE RIPTIDE – JUNIOR RIPTIDE 2018 Registration Form

ALL JUNIOR RIPTIDE PARTICIPANTS MUST BE AT LEAST THREE (3) YEARS OLD AND BE POTTY TRAINED Swimmer’s Last Name Father’s Name

Mother’s Name

Address 2° Email

1° Email Home Phone

Father’s Cell

Registration Fees Swimmer 1st Swimmer 2nd Swimmer 3rd Swimmer 4th + Swimmer *The Non-Resident fee is $25 per family

Mother’s Cell

Rivermoore Park Resident $130 $130 $125 $120

Non-Resident $155* $130 $125 $120

Participant Information Swimmer’s Name First, Middle Initial, Last

T-shirt Size

All swimmers receive a team T-shirt if they register by 5/1/2017

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 Junior Riptide Application

Registration Checklist – Riptide Use Only Birth Certificate(s)? Medical Form? Concussion Waiver? Volunteer Agreement? Amount Paid