Lethbridge Synchrobelles Synchronized Swimming Lethbridge, Alberta

Transcription

1 Spring/Summer 2013 Registration (Under 18) Swimmer Information: First Name: Middle Initial(s): Last Name: Address: City: PC: Phone: (Home) (Cell) Date of Birth: Age: How did you hear about Lethbridge Synchrobelles Synchronized Swimming Club? Program Information: What programs(s) are you registering for? Spring Programs Cost Ages 7-10 (Mon/Thurs 6:00-8:00 May 13-June 20, 2013) $110 Ages (Mon/Thus 6:00-8:00 June 3-20, 2013) $60 TOTAL Summer Programs Early Bird Rate (before May 1) Early Bird Rate Nonmember After May 1 Member Rate After May 1 Nonmember rate Member rate Explore Synchro Camp July 8-12, 2013 $75 $85* $85 $95 (8:30-12:00) Synchro Activity Camp July 22-26, 2013 $225 $235 $235 $245 (8:30-4:30) Synchro Activity Camp August 12-16, 2013 $225 $235 $235 $245 (8:30-4:30) Aquasquirts July 8-12, 2013 (9:00-11:00 am) $75 $85 $85 $95 Aquasquirts July 22-26, 2013 $75 $85 $85 $95 (9:00-11:00 am) Aquasquirts August 12-16, 2013 $75 $85 $85 $95 (9:00-11:00 am) Synchro Fit Camp August 26-30, 2013 $75 $85 $85 $95 (8:30-12:00) SUB-TOTAL Minus applicable discounts** TOTAL * Non-members only pay the $10 Synchro AB fee once (so if you register for multiple camps, you will pay the member rate on all subsequent camps) **Are you registering multiple swimmers or registering in more than one camp? Please deduct 10% off the cost of your second camp! Page 1 of 10

2 CAMP DESCRIPTIONS Synchro Activity Camp July 22-26, 2013 Drop off 8:30-9:00, pick up 4:30-5:00 For campers ages 7-17, with or without Synchro experience Campers get a T-shirt, nose clip, Swim cap Activities-Synchro, water polo, yoga, drama, dance Synchro Activity Camp August 12-16, 2013 Drop off 8:30-9:00, pick up 4:30-5:00 Campers ages 7-17, with or without Synchro experience Campers get a T-shirt, nose clip, Swim cap Activities-Synchro, water polo, yoga, drama, hooping Explore Synchro Choreography Camp July :30-12:00 Swimmers 7-17 with or without Synchro experience Campers get a T-shirt, nose clip, Swim cap AquaSquirts Camps July 8-12, July & August :00-11:00 Swimmers ages 5-7, no Synchro experience required Synchro Fit Camp August 26-30, 2013 Start off your season strong! 8:30-12:00 Swimmers 7-17 with or without Synchro experience Campers get a T-shirt, nose clip, Swim cap Page 2 of 10

3 Consent and Release (Parent/Guardian of Minor Swimmer) for Please print legibly. I, the undersigned, the lawful parent/guardian of (the Swimmer) hereby acknowledge that participation by the Swimmer in the programs and activities initiated, conducted or organized by Lethbridge Synchrobelles Synchronized Swimming Club (LSSSC) might result in personal injury, property damage or loss and possibly death to the Swimmer. The Swimmer and I fully understand these risks and hereby agree to participate voluntarily in said programs and activities and at our own risk. In consideration of LSSSC accepting the Swimmer s entry into the programs and activities initiated, conducted or organized by LSSSC, I and my heirs, executors, administrators and assigns hereby release, save harmless and agree not to hold LSSSC, its directors, officers, servants, agents, sponsors, volunteers or employees responsible for the Swimmer s personal injury, property damage or loss, death or any other claims or demands whatsoever resulting from or arising in connection with the Swimmer s participation in said programs and activities notwithstanding that any such claim or demand may arise out of the negligence of LSSSC, its directors, officers, servants, agents, sponsors, volunteers or employees. In further consideration of LSSSC accepting the Swimmer s entry into said programs and activities, I hereby provide my consent for the Swimmer to travel with LSSSC to those meets and other events organized by or for the participation of LSSSC as may arise from time to time during the swim year. I further consent to the Swimmer s involvement in all supervised activities organized by or for the participation of LSSSC during the swim year. I have carefully read this Consent and Release, fully understand it and am freely and voluntarily executing it. Dated at the City of Lethbridge, in the Province of Alberta, this day of A.D Name of Parent/Guardian: Signature: Name of Witness: Signature: Page 3 of 10

4 EMERGENCY TREATMENT AUTHORIZATION FORM for Please print legibly. In the event of any emergency involving, where I (Parent and/or Guardian) cannot be reached at any of the phone numbers on file, I (We) authorize the Lethbridge Synchrobelles Synchronized Swimming Club coach or the aid to seek medical attention for the noted swimmer. I understand that it is my responsibility to provide a new Emergency Treatment Authorization Form when the information herein changes. This permission is effective from May 1, 2013-August 31, 2013 while the swimmer is under the supervision of the coach. Signature of Parent /Guardian: Please print name: Signature of Swimmer if 18 years of age or over: Please print name: Date: Other Emergency Information: Alternate Emergency Contact: Name/Relation: Phone Number of Emergency Contact: Doctor s Name: Phone No. Swimmer s Alberta Health Care Number: Allergies for Swimmer: ( ) Yes ( ) No. IF YES, PLEASE LIST BELOW (any type) Does the swimmer have any medical problems which should be known ( )Yes ( ) No Please List: List any medications currently being taken: Page 4 of 10

5 Club Copy Synchro Alberta s PARTICIPATION AGREEMENT By signing this document you will waive certain legal rights, PLEASE READ CAREFULLY. IN CONSIDERATION of allowing my minor child/ward to participate in the programs, activities and events of Synchro Alberta, I ASSURE TO YOU THAT: 1. I am the parent/guardian of the participant having full legal responsibility for decisions regarding the participant. 2. I believe that my minor/ward is physically, emotionally and mentally able to participate in the programs, activities and events of Synchro Alberta. 3. I hereby acknowledge that I am aware of the risks and hazards associated with or related to the activities and events of Synchro Alberta. The risks and hazards include, but are not limited to injuries from: a) Executing strenuous and demanding physical techniques including boosts and lifts; b) Vigorous physical exertion, strenuous cardiovascular workouts, rapid movements and quick turns and stops; c) Exerting and stretching various muscle groups; d) Entering the water by either diving or jumping; e) Extended time underwater; f) Spending extended times in chlorinated water including bacterial infections and rashes; g) Dry land training including weights, pilates, running, dance, bands, circus school and massage; h) Falling or colliding with the pool, pool bottom, walls, stands, equipment or with other participants; i) Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment; j) Contact, colliding, falling or being struck by other participants, spectators or equipment; k) Spinal cord injuries which may render me permanently paralyzed; l) Travel to and from competitive events and associated non-competitive events which are an integral part of Synchro Alberta s activities. 4. Furthermore, I am aware that: a. Injuries sustained to my child/ward can be severe; b. My child/ward may experience anxiety while challenging himself/herself during the activities, events and programs; c. My child/ward may come into close contact with other participants, including the possibility of accidental and unexpected contact; d. My child/ward s risk of injury is reduced if he/she follows all rules established for participation; and e. My child/ward s risk of injury increases as he/she becomes fatigued. I UNDERSTAND AND AGREE, on behalf of myself, my heirs, assigns, personal representatives and next of kin that my signing of this document constitutes that: 5. I am registering my child/ward willingly and my child/ward is participating voluntarily in these activities, events and programs. 6. I agree that there are risks as described above and my child/ward will be exposed to these risks and hazards. 7. I agree to accept all these risks and hazards and be responsible for any injury or other loss which my minor child/ward might receive while participating in these events, activities and programs. 8. If something happens to my child/ward, I release Synchro Alberta of responsibility for any claims, demands, actions and costs which might arise out of my child/ward s participation. I understand Synchro Alberta to mean: Synchro Alberta, its directors, officers, committee members, members, employees, coaches, volunteers, officials, judges, participants, agents, owners/operators of facilities, and representatives. CONSENT FOR EMERGENCY MEDICAL TREATMENT I,, parent/legal guardian of, give permission to the officials and coaches of Synchro Alberta to make decisions concerning medical care and treatment, and where necessary to authorize such care and treatment in emergency situations. I understand that the officials and coaches of Synchro Alberta will make every reasonable effort, in the circumstances, to contact me regarding my child s/ward s medical status in the event an emergency arises. In the event that I cannot be reached in an emergency I hereby give my permission to the licensed physician, dentist, athletic therapist, nurse or other medical professional whose services might be required to provide medical care and treatment. By signing here, I indicate that I have the understanding and capacity to communicate health care directives for my child/ward and that I am fully informed as to the contents of this document and understand the full import of this grant of powers to the officials and coaches of Synchro Alberta. Dated: Parent/Guardian Signature I ACKNOWLEDGE MAKING THIS AGREEMENT I have read and understood the terms and conditions of this agreement, and by signing it voluntarily, I am agreeing to abide by these terms. Printed Name of Participant Signature of Participant Printed Name of Parent or Guardian Signature of Parent or Guardian Date Page 5 of 10

6 Club Copy Synchro AB Copy Synchro Alberta s PARTICIPATION AGREEMENT By signing this document you will waive certain legal rights, PLEASE READ CAREFULLY. IN CONSIDERATION of allowing my minor child/ward to participate in the programs, activities and events of Synchro Alberta, I ASSURE TO YOU THAT: 1. I am the parent/guardian of the participant having full legal responsibility for decisions regarding the participant. 2. I believe that my minor/ward is physically, emotionally and mentally able to participate in the programs, activities and events of Synchro Alberta. 3. I hereby acknowledge that I am aware of the risks and hazards associated with or related to the activities and events of Synchro Alberta. The risks and hazards include, but are not limited to injuries from: a) Executing strenuous and demanding physical techniques including boosts and lifts; b) Vigorous physical exertion, strenuous cardiovascular workouts, rapid movements and quick turns and stops; c) Exerting and stretching various muscle groups; d) Entering the water by either diving or jumping; e) Extended time underwater; f) Spending extended times in chlorinated water including bacterial infections and rashes; g) Dry land training including weights, pilates, running, dance, bands, circus school and massage; h) Falling or colliding with the pool, pool bottom, walls, stands, equipment or with other participants; i) Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment; j) Contact, colliding, falling or being struck by other participants, spectators or equipment; k) Spinal cord injuries which may render me permanently paralyzed; l) Travel to and from competitive events and associated non-competitive events which are an integral part of Synchro Alberta s activities. 4. Furthermore, I am aware that: a. Injuries sustained to my child/ward can be severe; b. My child/ward may experience anxiety while challenging himself/herself during the activities, events and programs; c. My child/ward may come into close contact with other participants, including the possibility of accidental and unexpected contact; d. My child/ward s risk of injury is reduced if he/she follows all rules established for participation; and e. My child/ward s risk of injury increases as he/she becomes fatigued. I UNDERSTAND AND AGREE, on behalf of myself, my heirs, assigns, personal representatives and next of kin that my signing of this document constitutes that: 5. I am registering my child/ward willingly and my child/ward is participating voluntarily in these activities, events and programs. 6. I agree that there are risks as described above and my child/ward will be exposed to these risks and hazards. 7. I agree to accept all these risks and hazards and be responsible for any injury or other loss which my minor child/ward might receive while participating in these events, activities and programs. 8. If something happens to my child/ward, I release Synchro Alberta of responsibility for any claims, demands, actions and costs which might arise out of my child/ward s participation. I understand Synchro Alberta to mean: Synchro Alberta, its directors, officers, committee members, members, employees, coaches, volunteers, officials, judges, participants, agents, owners/operators of facilities, and representatives. CONSENT FOR EMERGENCY MEDICAL TREATMENT I,, parent/legal guardian of, give permission to the officials and coaches of Synchro Alberta to make decisions concerning medical care and treatment, and where necessary to authorize such care and treatment in emergency situations. I understand that the officials and coaches of Synchro Alberta will make every reasonable effort, in the circumstances, to contact me regarding my child s/ward s medical status in the event an emergency arises. In the event that I cannot be reached in an emergency I hereby give my permission to the licensed physician, dentist, athletic therapist, nurse or other medical professional whose services might be required to provide medical care and treatment. By signing here, I indicate that I have the understanding and capacity to communicate health care directives for my child/ward and that I am fully informed as to the contents of this document and understand the full import of this grant of powers to the officials and coaches of Synchro Alberta. Dated: Parent/Guardian Signature I ACKNOWLEDGE MAKING THIS AGREEMENT I have read and understood the terms and conditions of this agreement, and by signing it voluntarily, I am agreeing to abide by these terms. Printed Name of Participant Signature of Participant Printed Name of Parent or Guardian Signature of Parent or Guardian Date Page 6 of 10

7 Consent for Use of Personal Information and Photo Release for I, the participant and/or parent/guardian, authorize Synchro Alberta and Lethbridge Synchrobelles Synchronized Swimming Club to collect and use personal information about me or my child for the purpose of receiving communications from Synchro Alberta and Lethbridge Synchrobelles Synchronized Swimming Club and posting articles of interest, newsletters, promotions, rosters, statistics, images and results on Synchro Alberta s and Lethbridge Synchrobelles Synchronized Swimming Club s website and on the club s Facebook page(s). Furthermore I, the participant and/or parent/guardian, grant permission to Synchro Alberta, Synchro Canada and Lethbridge Synchrobelles Synchronized Swimming Club to photograph and/or record my or my child s image and/or voice on still or motion picture film and/or audio tape, and to use this material to promote Synchro Alberta, Synchro Canada and Lethbridge Synchrobelles Synchronized Swimming Club through the media of newsletters, websites, television, film, radio, print and/or display form. I understand that the audio/visual material and copyright will remain the sole property of Synchro Alberta, Synchro Canada and Lethbridge Synchrobelles Synchronized Swimming Club and I waive any claim to remuneration for use of audio/visual materials used for these purposes. I understand that I may withdraw such consent at any time by contacting Synchro Alberta s Privacy Officer. The Privacy Officer will advise the implications of such withdrawal. Signature of Participant (if aged 13 and over) Signature of Parent Guardian (if under 18) Date *We do not sell or distribute your personal information to any other third party not listed herein.* Acceptance of Terms and Conditions for In consideration of the acceptance of my or my child s membership in Synchro Alberta, Synchro Canada and Lethbridge Synchrobelles Synchronized Swimming Club, I, the participant and/0r parent/guardian, agree as follows: 1. To abide by the policies, rules and regulations of Synchro Alberta, Synchro Canada and Lethbridge Synchrobelles Synchronized Swimming Club. 2. I have reviewed the waiver/participation agreement included in the registration package of Lethbridge Synchrobelles Synchronized Swimming Club and my signature affixed hereto indicates my agreement with such waiver/participation agreement. 3. I accept sole responsibility for my or my child s personal possessions and athletic equipment. I acknowledge that I have read this registration agreement in its entirety and I have executed this registration agreement voluntarily. Signature of Participant (if aged 13 and over) Signature of Parent Guardian (if under 18) Date Page 7 of 10

8 Parent Code of Conduct Parents must sign and return a copy of the Parent Code of Conduct prior to their child commencing the session. Parents are required to demonstrate a positive attitude, be courteous, and show respect towards all club members, coaches, swimmers, and all Synchro Alberta and Synchro Canada members. Parents are expected to show good sportsmanship at all times. Parents are encouraged to discuss progress and concerns with the Parent/Coach Liaison and/or their child s coach. If they wish to meet with the coach, these discussions are to take place before or after scheduled practices, at a time agreed to by the parent and coach. Parents are invited to watch the swimmers during practice in the observation areas provided by the facility. Parents are not to interfere with practices or competitions. Parents are not allowed on the pool deck at competitions, testing, etc. A general meeting for all parents is held annually. All parents must attend this meeting to keep informed about various activities with the Lethbridge Synchrobelles Synchronized Swimming Club (LSSSC). LSSSC, with the exception of the coaches, is staffed by volunteers. Parents are required to volunteer their services (e.g., swim meet operation, fund raising, coordinator, etc.), as needed during various swim meets, club events, and in the general operation of LSSSC. Parents are responsible to pay in full the swimming fees and other costs posted to their child s account including, if applicable, pay in full the previous balance of their child s account. Program fees do not represent their actual cost incurred by the club. Each family wishing to subsidize a swimmer s program fees may participate in various fundraising events and volunteer activities as outlined in the club s Financing and Volunteer Participation Policies. By signing below, Parents acknowledge that they have read, understand, and agree to information as outlined above. Name of Parent: Signature: Date: (Parent) Page 8 of 10

9 Swimmer Code of Conduct Swimmers and parents must sign and return a copy of the Swimmer Code of Conduct prior to commencing the season. Swimmers are expected to: Demonstrate a positive attitude towards the sport of synchronized swimming. Demonstrate good sportsmanship. Treat coaches and fellow swimmers with courtesy and respect. Be courteous to fellow competitors, other club coaches, and officials, and to conduct themselves appropriately. Be in attendance at and be on time for all swim meets. Support club swimmers by sitting together and cheering for all Lethbridge Synchrobelles Synchronized Swimming Club s (LSSSC) teams and routines. Attend the Award Presentations at all events. Follow all pool safety rules while on pool decks and in the change rooms. There is zero tolerance of: Offensive language, Rude or offensive behavior, Angry outbursts or disorderly behavior, Abuse of athletes, coaches, or officials, Use of alcohol, cigarettes or illegal drugs, Use of electronic communication devices and/or cameras in change areas. The coaching staff may solicit feedback from swimmers from time to time and this is expected to be open, honest, and constructive. Discipline will be applied as outlined in the LSSSC Discipline Policy. The LSSSC Executive, at its discretion, may terminate with notice a swimmer s membership in LSSSC and the swimmer will forfeit swim fees or other costs incurred by the swimmer up to one full month after termination prior to January 1 st, after which all swim fees may be forfeited. Name of Swimmer: Signature: Date: (Swimmer) Page 9 of 10

10 Information Policy The Lethbridge Synchrobelles Synchronized Swimming Club (LSSSC) encourages all members to review the details of the club s Private Information Policy by visiting All queries about the collection of Personal Information and the related policies should be addressed to the President of the LSSSC. Personal information collected on the various forms required by the LSSSC is considered confidential, will be treated accordingly, and will be used ONLY for the following purposes: Creation and maintenance of records for applying to and obtaining registration as a member of LSSSC, Synchro Alberta, and Synchro Canada; Creation of records for registering in program related competitions; Creation of an emergency contact list with contact and health information for practices and competitions will be provided to the Head Coach, specific Program Coaches, Parent Liaison, and President; Distribution of emergency contact information for a particular swimmer may be provided to Life Guards and Competition Officials; Creation and distribution of a club roster with Contact Information for communication purposes; and Creation and distribution of tax receipts. I acknowledge that I have read this information policy and understand and agree to the terms of use of personal information provided on the LSSSC s various forms. Date: Signature of Parent/Guardian or Swimmers (if 18 years of age or older) Page 10 of 10