Piranhas – Join – Parklawn Recreation Association

Swim Team Registration Form

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.
Family/Last Name: *
Father's Name: *
Mother's 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 CodeCountry
Father's Phone: *Please enter your best contact number here.
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?
Participation 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 agree

Swimmer Information:

Swimmer 1:

First Name: *

Last Name: *

Birthday: *mm/dd/yy

Swimmer'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.

Practice Time: Once morning practice begins on June 17, my swimmer will attend this practice:

Gender: *

MaleFemale

T-Shirt Size: *Please enter your swimmer's T-shirt size.

Swimmer 2:

First Name:

Last Name:

Birthday: mm/dd/yy

Swimmer'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.

Practice Time: Once morning practice begins on June 17, my swimmer will attend this practice:

Gender:

MaleFemale

T-Shirt Size: Please enter your swimmer's T-shirt size.

Swimmer 3:

First Name:

Last Name:

Birthday: mm/dd/yy

Swimmer'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.

Practice Time:

Once morning practice begins on June 17, my swimmer will attend this practice:MorningEvening

Gender:

MaleFemale

T-Shirt Size: Please enter your swimmer's T-shirt size.

Verification

Please enter any two digits *Example: 12
This box is for spam protection - please leave it blank:

PAYMENT OPTIONS

Pay Online (Credit Only)

When using the Pay Online option please make sure to add your swimmer’s name(s) to the note section. There is also a processing fee added to the final amount for all transactions.

Pay By Check

Please make checks payable to:
Parklawn Swim Team

Mail the check to:
Attn: Caroline Molina
6214 Woodland Lake Drive
Alexandria, VA 22310

Please make sure the check has Swim Team in the memo line.

Questions? Contact us at parklawnpiranhas@gmail.com.