Registration Information:

Please enter each swimmers information below:

* 100% cotton T-shirts. No size exchanges!  Late registration does not guaranty shirts.

**The coaching staff recommends swim caps during meets. 

If you would like to purchase an Orcas swim cap, you can order with registration.

Number of swim caps needed: ($10 each)

For parents or siblings additional team T-shirts are available for $10 each.

Enter  additional T-shirt Quantity by placing number of T-shirts needed of the sizes below: 

YS: YM: YL: AS: AM: AL: AXL: AXXL:

I certify that my child(ren) is/are physically fit to participate in all activities of the organization.

 *Initials

Parents and swimmers agree to be governed by the rules of PineBrookWood Orcas.

 *Initials

Waiver of Liability

• Having been informed of the intention of PineBrookWood Orcas to provide supervised meets and practice sessions, I, the parent or legal guardian of the above named applicant(s), do hereby give my approval for my child’s participation in any and all of its activities during the period to which this application pertains.  I assume all the risks and hazards incidental to the conduct of these activities; and hold harmless the organization, organizers, supervisors and sponsors of PineBrookWood Orcas.   *Initials

• On behalf of my child(ren) and myself, I do voluntarily elect to accept and solely assume all risks of injury incurred or suffered by my child (a) while practicing or playing as a member of the team so designated, (b) while serving in a non-playing capacity as team member or observer during practice or play by other teams or by other swimmers on my child’s team, and (c) while on or upon the premises of any and all of the pools arranged for by my team or league for practice or play.*Initials

• In addition to giving my full consent for my child’s participation, I do hereby waive, release, discharge and agree not to sue the PineBrookWood Orcas, the owner or operator of any pool utilized by the team, officers, agents, servants, associations, employees, or any person or entity connected with the team for any claim, damages, costs including attorneys fees, or cause of action which I or my child(ren) have or may have in the future as a result of damages, injuries, including death, sustained or incurred by my child(ren) from whatever cause.*Initials

• I hereby certify that my child(ren) is(are) fully capable of participating in the designated sport and that my child(ren) is(are) healthy and has no physical or mental disabilities or infirmities that would restrict full participation in these activities, except as made known to coaches and officials of the team and league.*Initials

• I further agree on behalf of myself and my child(ren) listed above, that I shall hold harmless and fully indemnify the parties hereby release from any and all claims, damages, costs including attorney fees, and causes of action which may arise from any cause of action made by me or by, through or on behalf of my child(ren), even if the damages, injuries or death are caused in whole or in part by any of the persons or entities hereby released.*Initials

Please indicate if you will allow or not allow your child(ren)s photo to appear on the PineBrookWood Orca's website.

I allow my child(ren)s photos to be used on the website. I DO NOT allow my child(ren)s photos to be used on the website.    *Initials

Medical Release Information

As the parent or guardian of the minor child(ren) listed on this form, I request that in my absence my child be admitted to any hospital or medical facility for diagnosis and treatment.  I request and authorize physicians, dentists, and staff, duty licensed as Doctors or Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the minor child(ren) listed on this form.  I authorize the hospital or medical facility to dispose of any specimen or tissue taken from the minor child.   *Initials

Family Physician    Physician Phone #

Insurance Carrier

Insurance Member Services Phone #

Name of Insured Parent/Guardian

Address

City State Zip

Home #    Work #   Cell #

Person responsible for charges (if different from above)

Address

City State Zip

Home #    Work #   Cell #

Emergency Contact Information

Person to notify if parent/guardian is unavailable:

Address

City State Zip

Home #    Work #   Cell #

Parent Volunteer Contract

The Orca Swim Team is a volunteer organization. To successfully run each swim meet, over 130 parent volunteers are required. Each family should expect to work a shift (half a swim meet) during every pre- and regular season meet, or 6 shifts throughout the season. Families with multiple children on the swim team may be needed for occasional additional shifts.  If your family will miss a swim meet, you may be asked to work more than one shift at another meet, especially for home meets that require larger numbers of volunteers.

Volunteer positions will be assigned by the volunteer cordinator, Melanie.  You can reach her at Volunteers@pinebrookwoodorcas.org or 713-416-4471.

We acknowledging that the ORCA Swim Team is an organization relying heavily on volunteers, agree to work my/our assigned shifts or personally make arrangements for another adult to work them.   *Initials