K-6th Otters Swim Team Prep
Dates: Nov. 2nd-Feb. 4th
Days: Mon., Tues. & Thurs.
Price: Members- $120 or $40/mo.
Non-Members- $240 or $80/mo.
*Additional Child Fee: $80 or $20/mo.

This program is for both novice and intermediate swimmers who desire to be on the OCHS swim team, but who are not yet able to meet all requirements. The Swim Team Prep is designed to help swimmers achieve the skills needed to advance to the next level!!
Email address *
Last Name *
First Name *
Age *
Date of Birth *
Address *
Gender *
Phone Number *
Parent/Guardian Last Name *
Parent/Guardian First Name *
Parent/Guardian Home Phone *
Parent/Guardian Cell Phone *
Parent/Guardian Email *
Does this child have any disabilities, handicaps, injuries, limitations, allergies, hemophilia, heart conditions, asthma or other respiratory conditions, diabetes or any other condition our program staff and volunteers need to be aware of? If yes, explain. *
Doctor's Name and Phone Number *
I understand the hazards of the novel coronavirus (COVID-19) and am familiar with the Centers for Disease Control and Prevention (CDC) guidelines regarding COVID-19. I acknowledge and understand that that the circumstances regarding COVID-19 are changing from day to day and that, accordingly, the CDC guidelines are regularly modified and updated and I accept full responsibility for familiarizing myself with the most recent updates. I acknowledge and fully assume the risk of illness or death related to COVID-19 arising from my being on the premises and participating in the Activities and hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE (on behalf of myself and any minor children from whom I have the capacity contract) Ohio County Family Wellness Center, officers, directors, agents, employees and assigns (the RELEASEES) from any liability related to COVID-19 which might occur as a result my being on the premises and participating in the Activities. A minor under the age of 16 may not be left unattended in the facility without proper supervision by a responsible adult at any time. This offense will result in warning or dissolution of membership contingent upon situation. I, the undersigned, parent or legal guardian of the participant, a minor, hereby authorize the Family Wellness Center staff, coaches and other participating parents acting in good faith and in the capacity of program volunteers, to serve as agents in my absence to consent in medical, surgical, and/or dental examination or treatment in case of emergency, and/or hospital care. If there is an emergency, and I cannot be reached, please contact the following emergency contact. PLEASE WRITE EMERGENCY CONTACT FULL NAME AND PHONE NUMBER(S) *
I, the parent or guardian of the above, do hereby acknowledge the risk of physical injury during participation in an athletic activity. I further acknowledge that I will hold harmless the Ohio County Family Wellness Center from any claims arising from injury to the above named participant. I acknowledge that I release the Ohio County Family Wellness Center from any liability should my child sustain harm and/or injury while participating in said program. I agree to enroll my child in the cheerleading program under the leadership of the Ohio County Family Wellness Center staff and volunteers. I agree that should I pay in monthly installments rather than the full amount up front, my account will be drafted monthly for the program regardless of attendance. PLEASE INITIAL BELOW. By entering your initials in the box below, you are effectively providing your signature, indicating that all the information on this form is true and accurate, to the best of your knowledge. *
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