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2010 PINEBROOKWOOD ORCA SWIM TEAM ONLINE REGISTRATION

 

There are 4 parts to Orca registration: Basic registration information, Waiver of Liability, Medical Information, and the Parent Volunteer Contract.  All parts are required for PineBrookWood Orcas membership.

 

Please enter your information on this page.  Once you hit the "submit" button, you will be directed to printable registration forms with your information filled out.  Please print these forms, sign where highlighted, and return them to PineBrookWood Orcas with your payment to be registered for the 2010 summer swim team. 

 

This is our first year to use this online method of registration.  Please double check your forms make sure the information is correct.  If there are any errors, please correct them on your printed/signed form.  We are not able to automatically calculate the fees at this time.  We are working on that for future registrations.

 

Please contact us if you have any further questions   registration@pinebrookwoodorcas.org

 

Thank you.

 

 

Registration Information:

 

Father's Name  Home #    Work # Cell #
Mother's Name Home #    Work # Cell #
Street Address Zip Code

eMail  

             (if more than 1 email address, sep by " ; "  )  

Subdivision

Please enter each swimmers information below:

  First Name

Last Name

 Birthday (mm/dd/yyyy) Male/Female

T-shirt Size*

Child 1
Child 2
Child 3
Child 4
Child 5

* 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.  They are $10 each.

Number of swim caps needed:

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

Enter  additional T-shirt Quantity: 

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

 

Waiver of Liability

 

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

 

 

 

Medical Release Information

Child

(as listed  above)

Last Tetanus Booster

Known allergies, allergies to medicine or other medical problems
Child 1
Child 2
Child 3
Child 4
Child 5

 

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

Please choose your top 4 preferred areas work during our swim meets.  The following jobs require training or certification: Starter/Referee, Stroke & Turn Judge, First Aid/EMT.

1st Choice
2nd Choice
3rd Choice
4th Choice

Note that although all attempts will be made to grant your preferences, you may be asked to work other areas as needed to fill openings:

 

Please check any meets you are not able to work any shifts:

May 22   (Intrasquad)

June 5    (@ PBW)

June 12  (@ PBW)

June 19  (@ PBW)

June 26  (@ Nassau Bay)

July 3     (@ CLC)

Please list any special circumstances for each swim meet requiring specific work considerations.  (e.g.: 5/22 can only work until 12 due to baseball game.)  Feel free to email if you need to submit more information.  volunteer@pinebrookwood.org