COLLEGE rowers winter break registration
Please bring a check or cash to your first practice. We're not running this through Regatta Central, so this will be your registration. Thanks and welcome back!!!
Rower and Contact Information
Rower Name (last, first) *
Your answer
Rower email *
Your answer
Rower phone number *
Your answer
Emergency Information
Emergency Contact (name and phone number) *
Your answer
If you are under 18, please have your parent fill out the following on your behalf.
These are the regular consents that ARC has used on Regatta Central for a number of year.
Parent name (first and last) giving consent and phone number.
Your answer
Medical Consent
I hereby authorize and consent to the administration of any and all medical, dental, and surgical examinations or operations and treatment or all other related care, including the administration of drugs, tests, anesthesia and/or blood transfusions that may be ordered by a physician and/or dentist in attendance at the medical center deemed necessary for myself or my son/daughter's emergency treatment. I hereby consent to the release of medical report(s) to any doctor or agency and consent to the admission of the above named minor person to the hospital.
I have read and agree to the above medical consent. Please type YES or NO. *
Your answer
Do you have any allergies (yes/no)? If yes, please elaborate. *
Your answer
Is there any other information you would like us to know in case of medical or other emergency? *
Your answer
Release of Liability
I understand that my participation involves rowing in an open craft in a physically demanding activity where there may be unusual risks to my health and safety. In addition, I understand that certain on-shore activities such as carrying boats, may pose unusual risks to my health and safety. My decision to participate in this program is made by me in full recognition of these risks and is entirely voluntary. I represent that I am in adequate physical condition to participate in these activities and that I will notify my coach if I have or if I develop any physical problem or health condition that may affect my ability to participate in these activities without posing a danger to my health or safety, or the health or safety of others. In consideration of your acceptance of this application, I hereby agree for myself, my executors, administrators and assigns to hold harmless Albany Rowing Center, Inc., its directors, officers, employees, representatives, successors, agents and assigns from all liability on account of any injury, loss, claim or damage to my health, well-being or property during my participation in this program.
I have read and agree to the release of liability. (Please type YES or NO.) *
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms