Swoop Time Athlete Membership Application
Member Last Name: *
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Member Name First: *
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Middle Initial:
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Date Of Birth *
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Member Age *
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Member Uniform Size: *
School: *
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Do you live in the United States? *
Home Address: *
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City: *
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State: *
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Zip Code: *
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Phone Number: *
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Email: *
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Gender: *
Are you a U.S. Citizen? *
Are you Hispanic or Latino? *
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What is your race? (Please select one or more races) *
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Sports Codes Please check all that apply: *
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How did you here about us? *
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Primary Parent Name (1) *
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Primary Parent (1) Email: *
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Primary Parent (1) Phone Number: *
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Relationship to athlete? *
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Primary Parent Name (2):
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Primary Parent (2) Email:
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Primary Parent (2) Phone Number
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Relationship to athlete?
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Payment Plans are available: *
Do you want to sign up for installments?
Emergency Contact Person: *
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Emergency Contact Number:
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Physician’s Name:
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Physician’s Name Phone Number:
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Hospital:
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Participation/Medical Release *
Participation/Medical Release This athlete has permission to participate with the Swoop Time Track Club in practices, meets, or other club functions. I hereby accept full responsibility for this participation for this and shall hold harmless the Swoop Time Track Club and their representatives for any and all damages that may result from his or her participation. In care of injury or illness, I hereby request that (if unable to reach a parent) the staff will contact the above noted person. If unable to reach that person, the club is authorized to take the athlete to a hospital or other medical treatment center, and I hereby authorize treatment.
Required
Image Release *
I give permission for the Swoop Time Track Club to use any photos or video images of my child to be published in an outlet used to promote or publicize our youth track program
Required
Code of Conduct *
As a spectator at the meets, you have an important responsibility to the participants . We need to set a good example for the kids in sportsmanship and ethics. These examples are especially important and challenged when a situation of disagreement arises during an event. If you find yourself upset over a players’ mistake, a coach’s decision or an o fficial’s judgment, please keep in mind the following: 1) Our players are not professionals and are discovering their sports skills and abilities. They are young athletes learning how to play together in a youth sporting environment. 2) Our coaches are individuals who enjoy working with the athletes. They are learning how to instruct and coach the athletes the best way they know how. They will provide feedback before, during and after the event . They need your support and trust in the decisions/ and or comments that are made during this process. They are not professionally trained. The coaches are volunteers devoting their time to this sport. 3) Our meet officials and volunteers are human, they make judgment calls which some will undoubtedly disagree . They interpret rules fairly and honestly. They too are continually learning more about the sport as well as dealing with disagreements. We ask spectators to aide by the following Code of Conduct and Remain in the spectator area during competition.
Required
ATHLETIC WAIVER AND RELEASE OF LIABILITY *
In consideration of being allowed to participate in any way in the Swoop Time Track Club, and related events and activities, the undersigned: 1. Agree that the parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating he or she should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she should immediately advise his or her coach or supervisor of such condition(s) and refuse to participate. 2. Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions, or negligence but the action, inaction, and negligence of others, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time. 3. Assume all the foregoing risks and accepts personal responsibility for the damages following such injury, permanent total disability or death. 4. Release, waive, discharge and covenant not to sue Swoop Time its affiliated clubs, their respective administrators, directors, agents, and other employees of the organization,other members/participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors or premises used to conduct the event, all of which are hereinafter referred to as “releases,” from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death and damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise. I HAVE READ THE ABOVE WAIVER AND RELEASE, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND SIGN IT VOLUNTARILY. TO BE COMPLETED BY PARENT OR GURDIAN IF ATHLETE IS UNDER 18 YEARS OF AGE )
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Parent/Guardian Signature:(type name) *
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