Swim Team / Dive Team Registration FormDive Team Instructions Divers, please fill in all boxes that swimmers fill in, including checking the waiver box. We will send you an additional diving waiver via email. Thank you.Instructions Please fill out all requested information and then submit the form after completing the verification. This form is best filled out on a desktop computer.Father's First Name: Father's Last Name: Mother's First Name: Mother's Last Name: Other Guardian's Name: Address: Please enter your home address and not a PO Box.Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryFather's Phone: Mother's Phone: Other Guardian's Phone: Father's Email: Mother's Email: Other Guardian's Email: Primary Contact: Which adult should be the primary contact for this swimmer?MotherFatherOther GuardianParticipation Waiver Acknowledgment: *Parklawn Recreation Association, Inc., Parklawn Piranhas Swim Team, Piranhas Power Booster Club, team representatives, Parklawn Board of Directors, coaches, instructors, parents, and volunteers will not be held liable for any injury, suffering, or other affliction resulting from participating in the Piranhas Swim Team or any meet. As Parent/Guardian of the above-name minor(s), I grant permission for the swimmer(s) to participate in all activities of the Parklawn Piranhas Swim Team, a Northern Virginia Swimming League (NVSL) member team. I represent and warrant that my minor child/children participating on the Parklawn Piranhas Swim Team are in good health and have no physical condition, ailment or disability which renders them unable to participate in vigorous physical activity. For and in consideration of benefits derived from participation in the Parklawn Piranhas Swim Team program, I understand that the risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. I understand that my swimmer’s participation is voluntary and participants (and parents/guardians of minors) will assume complete responsibility for participation. I assume all risks and hazards arising out of, or related to, such participation, including, but not limited to, transportation to and from such activities, and do hereby indemnify, release and hold harmless the Parklawn Recreation Association, Inc., Parklawn Piranhas Swim Team, its coaches, instructors, team representatives, volunteers, property manager, employees and agents, as well as the Northern Virginia Swimming League, Piranhas Power Boosters Club, and Parklawn Board of Directors, from all claims of any kind whatsoever which may arise or hereafter accrue in connection with my child’s/children’s participation in activities of the Parklawn Piranhas Swim Team, including without limitation, swim meets, swim practices, pep rallies, and social activities. I further grant permission for first aid to be given to my child/children in an emergency, and will be solely responsible for any medical costs which may arise. I AGREE THAT MY CHILD/CHILDREN WILL ABIDE BY THE NORTHERN VIRGINIA SWIMMING LEAGUE CODE OF CONDUCT. By checking the box below you agree to the above participation waiver statement.I agreePhoto Release Info: *I grant permission to Parklawn Recreation Association, Inc., Parklawn Piranhas Swim Team, Piranhas Power Booster Club, team representatives, Parklawn Board of Directors, coaches, instructors, parents, and volunteer (collectively, “Parklawn Swim Team”) the irrevocable and unrestricted right to produce photographs and video taken of my child, myself, and members of my family at a swim team function, including pep rallies, practice, swim meets and other activities, for any lawful purpose including publication, promotion, illustration, advertising, trade, or historical archive in any manner or in any medium, including the team’s Facebook page and other social media venues. I hereby release Parklawn Swim Team from liability for any violation or claims relating to said images or video. Furthermore, I grant permission to use the statements of my child, myself, or my family members given during an interview or evaluation with or without my name for the purpose of advertising and publicity without restriction to time limit or geographic area. I waive my right, my child’s rights, and my family’s rights to any and all compensation stemming from the use of these materials.I agreeSwimmer Information:Swimmer 1:First Name: Last Name: Birthday: mm/dd/yySwimmer's Email: Add if he/she has an email different from parent's email.Swimmer's Phone: Add if he/she has a number different from parent's number.Swimmer Allergies: Note any relevant allergies.Swim Team Practice Time: Once morning practice begins on June 17, my swimmer will attend this practice:MorningEveningGender: MaleFemalePlease Choose: *Please choose which team(s) you would like to join:Swim TeamDive TeamBoth TeamsT-Shirt Size: Please enter your swimmer's T-shirt size.Youth SmallYouth LargeAdult SmallAdult MediumAdult LargeAdult XLSwimmer 2:First Name: Last Name: Birthday: mm/dd/yySwimmer's Email: Add if he/she has an email different from parent's email.Swimmer's Phone: Add if he/she has a number different from parent's number.Allergies: Note any relevant allergies.Swim Team Practice Time: Once morning practice begins on June 17, my swimmer will attend this practice:MorningEveningGender: MaleFemalePlease Choose: Please choose which team(s) you would like to join:Swim TeamDive TeamBoth TeamsT-Shirt Size: Please enter your swimmer's T-shirt size.Youth SmallYouth LargeAdult SmallAdult MediumAdult LargeAdult XLSwimmer 3:First Name: Last Name: Birthday: mm/dd/yySwimmer's Email: Add if he/she has an email different from parent's email.Swimmer's Phone: Add if he/she has a number different from parent's number.Allergies: Note any relevant allergies.Swim Team Practice Time: Once morning practice begins on June 17, my swimmer will attend this practice:MorningEveningGender: MaleFemalePlease Choose: Please choose which team(s) you would like to join:Swim TeamDive TeamBoth TeamsT-Shirt Size: Please enter your swimmer's T-shirt size.Youth SmallYouth LargeAdult SmallAdult MediumAdult LargeAdult XLSwimmer 4:First Name: Last Name: Birthday: mm/dd/yySwimmer's Email: Add if he/she has an email different from parent's email.Swimmer's Phone: Allergies: Swim Team Practice Time: Once morning practice begins, my swimmer will attend this practice:MorningEveningGender: MaleFemalePlease Choose: Please choose which team(s) you would like to join:Swim TeamDive TeamBoth TeamsT-Shirt Size: Please enter your swimmer's T-shirt size.Youth SmallYouth LargeAdult SmallAdult MediumAdult LargeAdult XLRegistration Requirements *I understand that swim team requirements include the following three components: (1) completing and signing the registration form; (2) paying the swim team fees of $100 (one child) / $175 (two children) / $225 (three children) / $275 (four children); and (3) signing up to staff the snack bar for 3 shifts (4 hours each) during the summer at Sign Up Genius or paying to opt out ($200). Dive team fees are separate, and multi-swimmer discount only applies for swimmers who are on the swim team. Families must complete ALL of the registration requirements BEFORE their swimmer(s) will be allowed to attend swim team practice.I AgreeSign Up Genius Visit the Sign Up Genius WebsiteCode of Conduct and Waiver AcknowledgementsSocial Distancing and Practice Guidelines *I agree that my family and child(ren) will follow any social distancing and practice guidelines imposed by the Parklawn Piranhas Swim Team. I understand that the Parklawn Recreation Association, Inc. and Parklawn Piranhas Swim Team coaches, team reps, parents, swimmers, and volunteers are not responsible for monitoring or enforcing any social distancing guidelines or other policies established by the Parklawn Piranhas Swim Team.I agreeWarning and Assumption of Risk. I understand that my family and my children are participating in the intramural swim program (“Program”) at our own risk *The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The state of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and/or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID- 19 can cause serious and potentially life threatening illness and even death. Parklawn Recreation Association, Inc. and Parklawn Piranhas Swim Team cannot prevent me or my child(ren) from becoming exposed to, contracting, or spreading COVID-19 while participating in the Program. Therefore, I understand by choosing to participate in the Program, my family may be exposing ourselves, including my children, to or increasing our risk of contracting or spreading COVID-19. I HAVE READ AND UNDERSTOOD THE ABOVE WARNING CONCERNING COVID-19. I CHOOSE TO ACCEPT THE RISK OF CONTRACTING COVID-19 FOR MYSELF AND/OR MY FAMILY AND CHILDREN IN ORDER TO PARTICIPATE IN THE PROGRAM. THESE SERVICES ARE OF SUCH VALUE TO ME AND MY CHILDREN, THAT I ACCEPT THE RISK OF BEING EXPOSED TO, CONTRACTING, AND/OR SPREADING COVID-19 IN ORDER TO PARTICIPATE IN THE PROGRAM.I understandHealth Requirements *I AGREE THAT MY CHILD(REN) WILL NOT ATTEND SWIM PRACTICE IF MY SWIMMER OR ANY MEMBER OF MY FAMILY OR HOUSEHOLD IS EXPERIENCING ANY SYMPTOMS OF A FEVER (100.4°F OR HIGHER), COUGH, UNUSUAL FATIGUE, HEADACHE, LOSS OF SMELL OR TASTE, OR ANY OTHER COVID-19 LIKE SYMPTOMS OR HAS HAD ANY CONTACT EXPOSURE TO SOMEONE WHO HAS ANY SYMPTOMS (WHICH INCLUDES FAMILY AND FRIENDS, HOUSEHOLD MEMBERS, ETC.). This includes any swimmer, family member or household member who (a) has received a positive COVID-19 test or is presumed to have COVID-19 by a healthcare professional; or (b) has experienced a heightened risk of exposure to COVID-19 by attending an event, meeting or gathering where masks were not worn and physical distancing was not practiced and you have learned that someone who was at the same event, meeting or gathering has tested positive/is presumed to have COVID-19. I further agree that my child will not attend practice if my child is experiencing cold-like symptoms NOT described above or associated with COVID-19, a sinus infection, and allergies that may cause the swimmer to sneeze, cough or have a running nose. Any swimmer who doesn’t feel well for any reason should stay home until all of the swimmer’s symptoms have stopped. I also understand that as a condition of my family and my children’s participation in the Program that I agree to notify the swim team immediately if a family or household member has been or is suspected of having COVID-19. I consent to having my family and my child’s personal health information be used or disclosed as appropriate to facilitate the safety of Piranhas Swim Team.I agreeWAIVER AND RELEASE AND ASSUMPTION OF RISK FOR COMMUNICABLE DISEASES INCLUDING COVID-19 *In consideration of being allowed to participate in the Program and other activities and events (including training, practices, meets, etc.) sponsored or arranged by Parklawn Recreation Association, Inc. and the Parklawn Piranhas Swim Team (collectively, the “Activities”), the undersigned acknowledges, appreciates, and agrees that: 1. Participation includes possible exposure to and illness from various bacterial and viral infectious diseases including but not limited to Methicillin-resistant Staphylococcus aureus (MRSA), Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (“MERS”), influenza, and COVID-19. Risk of serious illness and death does exist, and cannot be entirely eliminated; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OR MISCONDUCT OF THE RELEASEES (as defined below), or others, and assume full responsibility for my participation in the Activities; and, 3. I willingly agree to comply with guidelines adopted by Parklawn Piranhas Swim Team from time to time for participation; and, 4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY FOREVER RELEASE AND HOLD HARMLESS AND WAIVE MY RIGHT TO BRING A SUIT AGAINST, Parklawn Recreation Association, Inc., Parklawn Piranhas Swim Team, Piranhas Power Booster Club, and any of their officers, directors, managers, team representatives, coaches, instructors, parents, volunteers, officials, agents, and/or employees, other participants or representatives, sponsoring agencies, sponsors, and advertisers (individually and collectively “RELEASEES”), WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or loss or damage to person or property in connection with the Activities, WHETHER ARISING FROM THE NEGLIGENCE OF RELEASEES OR OTHERWISE, to the fullest extent permitted by law, including in connection with exposure, infection, and/or spread of COVID-19 related to participating in the Activities. This document does not limit the applicability of any other document to which I am bound waiving or releasing Parklawn Recreation Association, Inc. or Parklawn Piranhas Swim Team, and/or assuming the risks associated with my participation in the Activities. I understand that this waiver means I give up my right to bring any claims including for personal injuries, death, disease, or property losses, or any other loss, including but not limited to claims of negligence and give up any claim I may have to seek damages, whether known or unknown, foreseen or unforeseen. I understand and agree that the law of the Commonwealth of Virginia will apply to this contract. I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS WAIVER, RELEASE AND ASSUMPTION OF RISK, AND UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY, UNDERSTANDING THAT EXECUTION OF THIS AGREEMENT IS A CONDITION TO MY PARTICIPATION IN THE ACTIVITIES.I agreeCERTIFICATION *This is to certify that I, as parent/guardian, with legal responsibility for the swimmers identified above, have read and explained the provisions in this document to my child/ward, including the risks of presence and participation in the Activities, and his/her personal responsibilities for adhering to guidelines adopted by Parklawn Piranhas Swim Team from time to time for protection against communicable diseases, and that such diseases may be contracted even if such guidelines are followed. Furthermore, my child/ward understands and accepts these risks and responsibilities. I for myself, my spouse, and child/ward do consent and agree to his/her release provided above for all the Releasees and myself, my spouse, and child/ward do hereby release and agree to indemnify and hold harmless the Releasees, for any and all liabilities or claims incident to my minor child’s/ward’s presence or participation in the Activities as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OR MISCONDUCT OF THE RELEASEES, to the fullest extent provided by law. In addition, on behalf of myself, my spouse and my child/ward, I assume the risk of myself, my spouse, and my child/ward contracting communicable diseases at the Activities, and/or providing transportation to my child/ward.I agree VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: