TIDALWAVES 2012 REGISTRATION FORM

Fill out information below (including health insurance provider, doctor, emergency contacts etc.)        SUBMIT REGISTRATION at bottom of page (please click only once and wait for confirmation message)   * required information

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   Swimmer Information

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	Name - Swimmer #1 * first last	Birthdate *  month       day       year --JanFebMarAprilMayJuneJulyAugSeptOctNovDec --01020304050607080910111213141516171819202122232425262728293031 --199119921993199419951996199719981999200020012002200320042005200620072008	Gender *  male female	Tidalwaves Swim Experience * new returning	High School Swim Team * noneRedwoodDrakeTamalpaisMarin AcademyMarin Catholicother
	Name - Swimmer #2 first  last	Birthdate month       day       year  --JanFebMarAprilMayJuneJulyAugSeptOctNovDec --01020304050607080910111213141516171819202122232425262728293031 --199119921993199419951996199719981999200020012002200320042005200620072008	Gender male female	Tidalwaves Swim Experience new returning	High School Swim Team noneRedwoodDrakeTamalpaisMarin AcademyMarin Catholicother
	Name - Swimmer #3 first  last	Birthdate month       day       year  --JanFebMarAprilMayJuneJulyAugSeptOctNovDec --01020304050607080910111213141516171819202122232425262728293031 --199119921993199419951996199719981999200020012002200320042005200620072008	Gender male female	Tidalwaves Swim Experience new returning	High School Swim Team noneRedwoodDrakeTamalpaisMarin AcademyMarin Catholicother

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  Parent Information

	Parent Name * first  last	email address *	Phone Numbers * home cell	Home Address * street city zip code
	Parent #2 Name first  last	email address	Phone Numbers home  cell	Home Address (if different from above) street city  zip code

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  Medical Information

	Health Insurance Company *
	Doctor's Name	Doctor Phone
	Dentist's Name	Dentist Phone
	Please list medical conditions or allergies for swimmer #1 Please list medical conditions or allergies for swimmer #2 Please list medical conditions or allergies for swimmer #3

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  Emergency Contacts

Emergency Contact * (other than parents) full name

Emergency Contact * (other than parents) phone

Emergency Contact #2 (other than parents) full name

Emergency Contact #2 (other than parents) phone

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  Service Commitment

	Volunteer Service Commitment *     As with other teams in the Marin Swim League, Tidalwaves depends on the active support of the swimmer’s parents during the season. At least one parent in each swimmer’s family is asked to work at swim meets in which the child participates, or assist with other team-related activities. Training will be provided for all jobs. All volunteers need to check in at the Check In Desk at each swim meet.     I agree to fulfill my service commitment. Each family will be required to complete at least 20 points worth of volunteer service (~20 hours) during the course of the 2012 Tidalwaves season. Jobs must be chosen on-line before February 10, 2012. Each job assigned to a family but not completed will be assessed a $30 per point fine. It is the responsibility of your family to know your assignments and to arrange a replacement if necessary. For this purpose, all jobs and volunteer contact information will be posted on-line. If you prefer, your service commitment will be waived upon receipt of your “buy-out” payment in the amount of $500. I Agree Buy-out ($500) After submitting your registration (below) please be sure to visit WWW.GOWAVES.COM/VOLUNTEERS to sign up for volunteer jobs
	Waiver & Release / Consent for Medical Treatment
	Waiver & Release / Consent for Medical Treatment * Download, Read, and Sign Liability Release Agreement and Waiver mail to: Larkspur Rec. Dept., 240 Doherty Dr., Larkspur, CA 94939-1532 I Agree with Waiver & Release Terms
	Submit Registration
	(please click only once and wait for registration confirmation message)