2020 NCS IMX Camp Athlete Application Form
ALL APPLICANTS MUST APPEAR ON THE FOLLOWING LIST OF IMX CAMP QUALIFIERS.

http://www.swimnc.com/wp-content/uploads/2019/08/2020-IMX-CAMP-ATHLETE-SELECTION-ROSTER-08-11-19.pdf

CAMP FEE:

I understand that this application is not complete until I submit payment of $170 for the IMX Camp fee using the PAYPAL link below. IMX CAMP FEE IS NON-REFUNDABLE.

SUBMIT PAYPAL PAYMENT (click the following link to connect with PayPal)

https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=GZKAHYMXWPVD4

CONSENT and RELEASE STATEMENT:

I agree to allow my child to participate in the 2020 IMX Camp in Greensboro on December 28-29, 2020. I further agree to release from all liability USA Swimming, Inc., NC Swimming, Inc., the event organizers, staff, manager, chaperones, and facility host Greensboro Aquatic Center for any and all injuries suffered by my child during the weekend camp. I understand that if my child violates the NCS Code of Conduct while on this trip that he or she can be dismissed immediately from the camp and that I am responsible for providing my child with transportation to and from the IMX Camp activities. Further I authorize medical personnel to treat my child should an emergency arise and medical care be needed.

NC SWIMMING IMX CAMP CODE OF CONDUCT: (click the following link to view)

http://www.swimnc.com/wp-content/uploads/2019/08/NC-SWIMMING-IMX-CAMP-CODE-OF-CONDUCT.pdf

NC SWIMMING TEAM TRAVEL POLICY: (click the following link to view)

http://www.swimnc.com/wp-content/uploads/2019/08/General-Team-Travel-Agreement.pdf

By my electronic signature below, I, as the parent or legal guardian of a participating athlete in this camp, agree to the Consent and Release statements above. Parent or legal guardian and participating athlete also acknowledge by their electronic signatures below that they have received, read, understand, and agree to the terms of the NC Swimming IMX Camp Code of Conduct and the NC Swimming Team Travel Policy.

APPLICATION DEADLINE: October 10, 2019
Email address *
Parent Electronic Signature *
I have read and agree to all of the above - type in your full name
Your answer
Athlete Electronic Signature *
I have read and agree to all of the above - type in your full name
Your answer
Athlete's Last Name *
Your answer
Athlete's First Name *
Your answer
Preferred Name *
Your answer
Street Address *
Your answer
City/State/Zip *
Your answer
Home Phone *
Your answer
Parent's Cell Phone *
Your answer
Athlete's NC Swimming Club *
Your answer
Athlete's Current Club Coach *
Your answer
Parents'/Guardians' Name(s) *
Your answer
Athlete's T-shirt size *
Athlete's Fleece Jacket size *
Please request size in female or male style
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Doctor's Name *
Your answer
Doctor's Phone Number *
Your answer
Medical Insurance Carrier and Member Number *
Your answer
Known Medical Conditions or Allergies (including food allergies) *
Your answer
List any special dietary needs or restrictions *
Your answer
Camp Fee has been paid using PayPal link above. *
Application is not complete until Camp Fee has been received.
Required
I understand that the Camp Fee is non-refundable. *
Required
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service