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DHSC Swim Team & Conditioning Authorization and Consent Form 2025
Registration Form
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* Indicates required question
Swimmer's Name
*
Your answer
Swimmer's Date of Birth
*
Your answer
Grade
*
Your answer
Previous Swim Team Experience?
*
Returning DHSC team member
Other swim team: ____________________
No previous swim team experience
Required
Will the swimmer train/practice for both level 1 and level 2 sessions a majority of the time? If unsure, select "No".
*
Yes
No
Does this Participant have a sibling registering for the swim program? If yes, enter name(s) below: (separate form is required for each participant)
Your answer
Confirmation of Registration and payment information notification should be sent to my e-mail address below:
*
Your answer
Parent/Guardian's Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Home Telephone
*
Your answer
Mobile Telephone
*
Your answer
E-Mail Address
*
Your answer
Secondary Emergency Contact NAME and PHONE NUMBER:
*
Your answer
Family Physician
*
Your answer
Telephone - Family Physician
*
Your answer
Medical Insurance Company
*
Your answer
Policy/Group #
*
Your answer
Family Dentist
*
Your answer
Telephone - Family Dentist
*
Your answer
Policy/Group #
*
Your answer
Please use this space to furnish any medical information that might be useful to the above named agent in case of an emergency.
Your answer
Date of last Tetanus Shot:
*
Your answer
List any known Allergies:
Your answer
Consent to Emergency Medical/Dental Care:
*
Consent to the medical/dental care in the case of an emergency
Do NOT consent to medical/dental care in the case of an emergency
Required
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