Woodland Hills WAHOOS 2011 Swim Team
www.wahoos.org wahoomail@yahoo.com

Swimmer Information

* Family Name

* Home Phone Number

* Neighborhood

* Mailing Address

Family Email Address

Tell us about the swimmers

	Swimmer 1	Swimmer 2	Swimmer 3	Swimmer 4
Name (first and last)
Date of Birth
Male or Female
5, 10, 15 year swimmer or Senior?

Parent/Guardian Information

* First and Last Name

* Contact Number

* Relationship to Swimmers:

Parent

Guardian

Place of business, address, phone number

First and Last Name

Contact Number

Relationship to Swimmers:

Parent

Guardian

Place of business, address, phone number

Emergency Contact

* Emergency Contact/other than parent or guardian

* Contact Number

Relationship to Swimmer

* Family Physician Name and Number

Health Insurance Company, Group or ID number, and pre-certification phone number

Volunteer Sign-up Availability

Time Trials

Time Trials May 7th @home WAHOO run meet

Black and Red

Black and Red May 14th(@home) WAHOOS only

Bear Branch

Bear Branch May 21th(@home) WAHOOS only

Mills Branch

Millls Branch May 28th(AWAY MEET)

Summerwood

Summerwood June 4th@home

Kings River

Kings River June 11th(AWAY MEET)

Trailwood

Trailwood, June 18th @home

DIVISIONALS

Divisionals June 25th(AWAY MEET)

I have access to a computer and the internet and I have/will have gone to the wahoos website to read the handbook. I understand that I am responsible for volunteering no less that 5 times this season in order to receive volunteer deposit back at the awards ceremony. I also understand that I am responsible to work at least once in the concessions area and at least once in the Pool Area Cleanup this season. If I do not, then I understand that I will not recieve my deposit back from the WAHOOs.

Agreed to by parent/guardian name completing form

Further, as the parent or legal guardian of the child(ren) I am registering, I hereby give my full consent and approval for my child(ren) to participate as a team member for the Woodland Hills Swim Team.
I understand that there are certain risks of injury inherent in the practice and play of this sport, as well as in traveling and other related activities incidental to my child’s participation. I am willing to assume these risks on behalf of my child(ren). I hereby certify that my child(ren) is/are fully capable of participating in the designated sport and that my child(ren) are healthy and have no physical or mental disabilities or infirmities that would restrict full participation in these activities, except as listed below in the specified section of this form.
In addition to giving my full consent for my child(ren)'s participation, I do hereby waive, release and hold harmless the Woodland Hills Swim Team including its board officers, coaches, sponsors, supervisors and representatives for any injury that may be suffered by my child in the normal course of participation in the designated sport and the activities incidental thereto, whether the result of negligence or any other cause.
I also give consent to the WHST Board and Coaches to seek medical treatment for my children registered with this form in the event that I, nor any of my emergency contacts listed are able to be reached. If the doctor indicated is not available for contact I give my authority for the emergency room doctor at the closest medical facility to treat my child(ren).

Agreed by parent/guardian (name)

The swim team registration fee is
$100.00 for the first swimmer in a family
$55.00 for the second swimmer in a family
$55.00 for the third swimmer in a family
fourth, fifth, and beyond in a family will not be charged a registration fee.

NEW THIS YEAR: EVERY SWIMMER 1ST, 2ND, 3RD, 4TH, 5TH, etc. will need to pay the pool usage fee of $5 each to offset the cost incurred by the home owners association for use of the pool. Please include this amount in your registration check, not your deposit.

(The family deposit check amount is $150.00 for the entire family, this check may be returned at the conclusion of the season, and is seperate from registration fee.)

Your total registration due will be:

$100 1 swimmer + $5 per swimmer fee= $105

$155 2 swimmers + $5 per swimmer fee = $165

$210 3 swimmers + $5 per swimmer fee = $225

$210 4 swimmers + $5 per swimmer fee = $230

$210 5 swimmers + $5 per swimmer fee = $235

$210 6 swimmers + $5 per swimmer fee = $240

More than 6 swimmers, fill in amount due=

I give Woodland Hills Swim Team consent to send me emails in using bulk form to the family email address provided by me in order to receive information and updates about practice, meets and the team.

agree

disagree

* Indicates Response Required