East Liverpool Area YMCA Competitive Swim Team 

REGISTRATION FORM 

 

INSTRUCTIONS: Please complete the entire form and return the form with all of your participant’s registration materials. 

 

PLEASE PRINT ALL INFORMATION

TODAY’S DATE: ______________ 

Swimmer Name ________________________ Sex M F DOB ____/____/____ Age ___________ (As of October 1, 2009) 

Sizes: T-Shirt _______

Home Address_________________________________________ City_________________ Zip ______________ 

 

Home Phone #____________________________ E-Mail Address ______________________________ 

 

Parent/Guardian’s Name ___________________ Work Phone ______________ Cell Phone _________________ 

 

Emergency Contact Name ______________________ Phone _______________Cell Phone _________________ 

(Other than parent) 

Special Medical Information_____________________________________________________________________

 

AGREEMENT / WAIVER 

 

    I herby certify that my child is in normal health and capable of safe participation in the YMCA Competitive Swim Team Program. I assume all risks and hazards incidental to the conduct of this program. I hereby authorize the YMCA to obtain medical treatment for my child in the event that I, nor my emergency contact, cannot be reached. 

 

    I support the YMCA Competitive Swim Team philosophy, which is based on: participation, fun, physical fitness, health, skill development, team work, fair play, family involvement, and volunteer leadership. 

 

    I have received and reviewed the parent handbook for the Youth Swim team. 
 

INFORMATION CONSENT & RELEASE STATEMENT

    “In consideration of my participation in the activities of the Young Men's Christian Association - East Liverpool Area, I do hereby declare myself to be medically able to participate in the activities of the YMCA - East Liverpool Area. (I understand that there are risks involved in all physical activities and I agree to familiarize myself with all equipment, facilities, rules and physical demands related to the activities I undertake). I agree to hold free from any and all liability the YMCA - East Liverpool Area and its respective officers, employees, members, volunteers, and sponsors and do hereby for myself, my heirs, executors and administrators waive, release and forever discharge any and all rights and claims for damages which I may have or which may hereafter accrue to me arising out of or connected with my participation in any of the activities of the YMCA - East Liverpool Area." I agree that my consent and this release are irrevocable. I hereby release and discharge The East Liverpool Area Family YMCA, YMCA of the USA and third parties collaborating with The East Liverpool Area Family YMCA and/or YMCA of the USA from any and all claims in connection with the uses and reproductions of any video film, footage, sound track recordings and photo reproductions of me and/or my narrative account of my experience East Liverpool Area Family YMCA.

 

 

______________________________________               ________________ 

Signature of Parent/Guardian                                             Date of Registration 

East Liverpool Area YMCA Competitive Swim Team 

PERSONAL GOAL SHEET 

 

INSTRUCTIONS: Please complete and return to the coaches. 

Please print all information (your parents may help you!) 

 

Name _________________________ Birthdate ___/___/___ Age ___________ 

 

List three of your hobbies: ________________________________________________________________ 

 

________________________________________________________________ 

 

________________________________________________________________ 

 

What goals do you wish to achieve as a member of the YMCA Competitive Swim Team? 

(for example: swim in dual meets, swim in AMS events) 

________________________________________________________________ 

 

________________________________________________________________ 

 

How can the coaches help you achieve your goals? ________________________________________________________________ 

 

________________________________________________________________ 

 

List your best strokes and your best times in those strokes: (Please see examples below) 

50 Free :23.00 100 Free :54.00 200 IM 2:00.00 

 

1.___________________ 2. ____________________ 3. _________________ 

 

Have you ever been on a relay? Yes No 

 

Which relay? (Please Circle) 200 Free 400 Free 200 Medley 

 

What did you like best about the relays?

________________________________________________________________ 

 

 

Please return to Coach Maria. 

 

 

 

 

 

 

 

East Liverpool Area YMCA Competitive Swim Team 

ATHLETIC CODE OF CONDUCT 

 

INSTRUCTIONS: Please read the entire YMCA Competitive Swim Team Athletic Code of Conduct, and complete the requested information on the lower portion of this form. Please return the lower portion of this form with your participant’s registration materials. 

 

The undersigned participant agrees to abide by the standards of conduct outlined below in addition to those established by coaches. Any additional standards regarding conduct will be addressed by the Aquatic Director and coaches, whose combined responsibilities will be to inform the team and the parents. 

 

    The possession or use of alcohol, tobacco, or any non-prescribed drugs is strictly prohibited. 

 

    Athletes are expected to follow the directions of the coaching staff. 

 

    Athletes will refrain from all illegal or inappropriate behavior that would detract from a positive image of the team or be detrimental to the team’s performance objectives. 

 

    Athletes will display proper respect and sportsmanship towards coaches, officials, administrators, fellow competitors, and the community at large. 

 

    Failure to comply with the Athletic Code of Conduct may result in, but not necessarily be limited to, any or all of the following actions: 

A. Athlete not be allowed to participate in some or all team activities, parent notification. 

B. Athlete sent home, parent notification. 

C. Upon notification of any violation of the standards, the coaching staff and the Aquatic Director shall further review the situation, promptly determine what disciplinary action, if any, shall be taken. 

 

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(Detach and return with registration materials) 

COMPETITIVIE SWIM TEAM ATHLETIC CODE OF CONDUCT 

 

Athlete’s Name ___________________________________ Age ____________ 

 

Parent’s Signature _________________________________ Date ___________

 

Coach’s Signature _________________________________ Date ___________