2019 Indian Lake Swim Team Registration Forms
Welcome to ILST Warriors! We are excited to have you and your swimmer are on our team this summer! Please be sure to complete this form in its entirety for EACH swimmer you wish to register. At the end of this form, you will find a link to either pay online or you may choose to mail your payment directly to our team rep. Thank you!
Email address *
Swimmer's LAST Name *
Your answer
Swimmer's FIRST Name *
Your answer
Swimmers Gender *
Swimmers DOB *
MM
/
DD
/
YYYY
Age group of swimmer as of June 1st, 2019: **minimum age 4 years + able to swim 25 yards unassisted. *
Please select ONE of the following options: FULL Roster Swimmer = $155.00 Includes 4 regular season meets, daily practices, team t-shirt, latex team swim cap + awards night banquet. PARTIAL Roster Swimmer = $80 **Must be in Middle or High School & legal in all 4 strokes** Includes 4 regular season meets, ONE practice a week, a team t-shirt, latex team swim cap + awards night banquet. *
Swimmers FREE Team T-Shirt Size (Sponsored by Morris Orthodontics) *
Has your swimmer been a member of a year round swim team? Ex. MTSC, NAC, YMCA, Middle School, High School etc. *
Parent/Guardian LAST Name *
Your answer
Parent/Guardian FIRST Name *
Your answer
Address *
Your answer
Primary Phone Number *
Your answer
Insurance Carrier *
Your answer
Insurance Policy/ID Number *
Your answer
Insurance Phone Number *
Your answer
Known Allergies for your swimmer *
Your answer
Other Medical Conditions or Physical Limitations. *
Your answer
Emergency Contact Full Name (not parent/guardian) *
Your answer
Emergency Contact Phone Number *
Your answer
I understand that our family's ILFSTC membership must be in good standing in order for my child to participate on the swim team. *
MEDICAL RELEASE WAIVER: I certify that I am the parent or legal guardian for my child. I hereby give my permission for any supervisor, coach or other team administrator associated with the Indian Lake Warriors to seek and give appropriate medical attention for our child in the event of accident, injury, illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment. *
I hereby waive, release and forever discharge Indian Lake Warriors and associated supervisor, coach or other team administrator from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Indian Lake Warriors activities, whether or not damages or loss is due to negligence. I hereby acknowledge that my child is physically fit and capable of participation in all swim team activities. *
LIABILITY RELEASE: By registering my child with the Indian Lake Warriors Swim Team, I agree to participate (or allow my child and family members to participate) in the Indian Lake Warriors Swim Team, and hereby release Indian Lake Warriors Swim Team, its bond holders, board of directors, officers, agents, coaches, and employees from liability for any injury that might occur to myself (or to my child and family members) while participating in the Indian Lake Warriors Swim Team program, including travel to and from training sessions, swim meets or other scheduled team activities. I agree to indemnify and hold harmless the above mentioned organizations and/or individuals, their agents and/or employees, against any and all liability for personal injury, including injuries resulting in death to me, my child(ren) and/or other family members, or damage to my property, the property to my child(ren) and/or other family members, or both, while I (or my child or family members) participating in the Indian Lake Warriors Swim Team program. *
PHOTO RELEASE: I grant to Indian Lake Warriors Swim Team, Indian Lake Forest Swim and Tennis Club, its representatives and employees (ILST) the right to take photographs of me and my child(ren) in connection with activities related to the Indian Lake Swim Team and its events. I further authorize ILST, its assigns and transferees the right to copyright, use and publish the same in print and/or electronically.I agree that ILST may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. *
PARTICIPATION AGREEMENT:
I have read and understand the above Participant Agreement. *
Required
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