Piranhas – Join

Dive 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 CodeCountry

Father'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?

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

Photo 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 agree

Swim Team / Dive Team Registration Form

Swimmer Information:

Swimmer 1:

Swimmer 2:

Swimmer 3:

Swimmer 4:

Code of Conduct and Waiver Acknowledgements

Verification