Swim Team Contact Information *Age as of June 1 st Swimmer #1 Name:___________________________ Birthday: ___/___/_____ Age:____ Asthma: Y __ N __ Allergies:_______________________________________ Medications:____________________________________________________ Other important information we should know about (i.e. injuries): ______________________________________________________________ Swimmer #2 Name:___________________________ Birthday: ___/___/_____ Age:____ Asthma: Y __ N __ Allergies:_______________________________________ Medications:____________________________________________________ Other important information we should know about (i.e. injuries): ______________________________________________________________ Swimmer #3 Name:___________________________ Birthday: ___/___/_____ Age:____ Asthma: Y __ N __ Allergies:_______________________________________ Medications:____________________________________________________ Other important information we should know about (i.e. injuries): ______________________________________________________________ Parent and/or Legal Guardian Information: #1)Name:___________________________ Relationship:________________ Address:________________________________ City:___________________ _________________________ (All Swim Meet Information sent via ) Home Phone:___________________ Work Phone: ___________________ Cell Phone:____________________ #2)Name:____________________________ Relationship:______________ Home Phone:____________________ Work Phone:___________________ Cell Phone:_____________________ Please Continue on Back Side Swim Team Fee Paid ($30 Individual/ $50 Family) Cash________ Check # _________ Initials:_______________

Emergency Contact: Contact #1: Name:____________________________ Relationship:_____________ Home Phone:____________________ Work Phone:_______________ Cell Phone:______________________ Contact #2: Name:____________________________ Relationship:_____________ Home Phone:____________________ Work Phone:_______________ Cell Phone:______________________ Notice of Risk: I understand that participation in athletic activity is dangerous and my expose me to risk of serious bodily injury and possibly death. These risks include, but are not limited to, the possibility of collisions with other participants, spectators and the public, vehicle accidents while traveling to and from such activities, and equipment failure. I understand that no degree of care or caution can completely eliminate these risks. Assumption of Risk, Release of Liability, Requirement to Maintain Insurance: I hereby freely and expressly assume and accept any and all risk of injury and/or death arising from my participation in any and all athletic activities I may undertake by or through FLANAGAN FLYERS SWIM TEAM, or while traveling to and from such activities, or from the use of any equipment provided or furnished to me by FLANAGAN FLYERS SWIM TEAM. I hereby release FLANAGAN FLYERS SWIM TEAM from all liability, including, but not limited to, liability for negligence, failure to warn, product liability and warranty arising out of or in any way connected with my participation in athletic activities. Furthermore, I promise and agree not to make any claim or commence any lawsuit against FLANAGAN FLYERS SWIM TEAM for injuries or damages arising from my participation in such activities or from the use of such equipment. As to the use of any equipment provided or furnished to me by FLANAGAN FLYERS SWIM TEAM, I expressly disclaim any and all warranties connected with such equipment. I have inspected and agree to accept such equipment “as is,” and agree that there are no warranties with respect to such equipment which extend beyond the face of this agreement. I also acknowledge that I am required to carry and maintain my own accident and health insurance sufficient to meet all costs and expenses which I might incur as a result of any injury I might sustain while participating in athletic activities, I acknowledge that I am presently covered by such health insurance. I have carefully read this agreement and fully understand its contents. I am aware that this is a release of important legal rights and a disclaimer of important warranties, that I am signing this agreement in consideration of my participation in athletic activities, and that this agreement is an enforceable contract between myself and FLANAGAN FLYERS SWIM TEAM, which I sign freely and voluntarily. Signature of Parent or Guardian: Printed Name of Parent or Guardian: ________________________________________________________________ Date:________________________