Greater Scranton YMCA Swim Team Registration
Swimmer's Last Name *
Your answer
Swimmer's First Name *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Swimmer's Age *
Your answer
Swimmer's Birthday *
MM
/
DD
/
YYYY
Swimmer's Gender *
Are you new to our team? *
If you are not new to our team, what year did you join? *
Your answer
For which season are you registering? *
Parent's Names - (First names are fine if the last name is the same as the swimmer. If different, please specify) *
Your answer
Home Phone - (include area code) If you don't have a home number & only use a cell, you can state that here. *
Your answer
Cell Phone - (include area code) Feel free to list multiple numbers, just indicate to whom each number is associated. *
Your answer
What phone is your preferred contact number? *
Primary E-mail Address *
Your answer
Secondary E-mail Address - (if you don't have a 2nd e-mail address, please enter n/a) *
Your answer
Does your swimmer have any health/physical conditions of which the coaches need to be aware? *
If so, please explain (if not type n/a) *
Your answer
Emergency Contact - (Please provide name, phone# & relationship) *
Your answer
Parents Signature - (Permission and approval is granted by me to have my child take part in the instructions & activities of the Greater Scranton YMCA Stingray Swim Team. Should a medical emergency arise during my child's participation , I understand that reasonable effort will be made to contact me or the emergency contact I have provided. If I cannot be reached, or if it is believed that my child's life or health may be adversely affected by the delay that an attempt to contact me would cause, I consent to the administration of medical treatment and/or surgical procedures deemed necessary by the medical doctor and/or medical facility chosen by the Greater Scranton YMCA and I consent to the immediate administration of life sustaining measures deemed necessary under the circumstances. By typing my name below, I am giving my electronic Signature. *
Your answer
Date (Please type in today's date.) *
MM
/
DD
/
YYYY
Permission to use Photos - (It is possible that we will be sending pictures of the team to the local newspapers along with press releases to swim team activities. We may also want to be able to post pictures of the swimmers on the bulletin board at the YMCA and on this website. Please indicate your preferences below by checking the boxes, then type your name in the next question to grant permission. If you would rather not have your child's image used for any purpose, check that box and type your name into the space indicating that you do not give permission *
Required
Signature for Photo Permissions - I hereby release the Greater Scranton YMCA, its employees, officers, affiliates, parents and subsidiaries, and the Greater Scranton YMCA swim team, its members, parents, committees and their agents, assigns and designees from any and all claims and demands arising out of or in connection with the reasonable and authorized use, or the negligent, accidental or inadvertent release of the photographs and personal information being authorized for the uses set forth herein, including but not limited to any claims for defamation of invasion of privacy. By typing my name below, I am giving my electronic signature to use my child's image for the uses checked in the previous question. *
Your answer
Signature to Decline Photo Permissions - I would prefer that my child's image not be used, and do not give my permission. By typing my name below, I am providing my electronic signature indicating that I do not want my child's image to be used.
Your answer
Have you completed your Volunteer Clearances? - This is required to work with the kids on deck during a meet, so we really need parents to complete this process. More information can be found on the Parent Page of the team website *
Which of the following clearances have you completed? *
Required
Please select the Volunteer "Jobs" you are interested in doing at our meets *
Required
Does your swimmer also swim for an area High School? *
If so, What High School Team are they a member of - If not a high school swimmer, please enter n/a. *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Greater Scranton YMCA. Report Abuse - Terms of Service - Additional Terms