Swim Lessons Registration FormPlease Acknowledge:* *Our family is a Parklawn MemberYesNoInstructions 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.Parent InformationFather's First Name: Father's Last Name: Father's Phone: Father's Email: Father's 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 SamoaYemenZambiaZimbabweCountryMother's First Name: Mother's Last Name: Mother's Phone: Mother's Email: Mother's Address if different from above: 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 SamoaYemenZambiaZimbabweCountryOther Parent or Guardian's First Name: Other Parent or Guardian's Last Name: Other Parent or Guardian's Phone: Other Parent or Guardian's Email: Other Parent or Guardian's Address if different from above *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 SamoaYemenZambiaZimbabweCountryPrimary Contact: Which adult should be the primary contact for this swimmer?MotherFatherOther Parent/GuardianParticipation Waiver Acknowledgment: *As Parent/Guardian of the above-named minor(s), I grant permission for the diver(s)/swimmer(s) to participate in all activities of the Parklawn Mini-Piranhas. I represent and warrant that my minor child/children participating on the Parklawn Mini-Piranhas 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 Mini-Piranhas program, I understand that the risk of injury to my child/children 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 Mini-Piranhas, Parklawn Recreation Association, Inc., Piranhas Power Booster Club, and their respective board members, coaches, instructors, team representatives, volunteers, property manager, employees and agents 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 Mini-Piranhas, including without limitation, swim/dive meets, swim/dive 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 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 FAMILY AND MY CHILD/CHILDREN WILL ABIDE BY THE PARKLAWN PIRANHAS CODE OF CONDUCT.I agreeCOVID-19 Waiver *COVID Waiver: An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is a contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and individuals with underlying medical conditions are especially vulnerable. The Northern Virginia Swimming League (NVSL) cannot prevent you (or your child(ren)) from becoming exposed to, contracting, or spreading COVID-19 while participating in NVSL-sanctioned events. It is not possible to prevent against the presence of the disease. Therefore, if you choose to participate in a NVSL-sanctioned event, you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. BY ATTENDING OR PARTICIPATING IN PRACTICE OR COMPETITION, YOU VOLUNTARILY ASSUME ALL RISKS ASSOCIATED WITH EXPOSURE TO COVID-19 AND FOREVER RELEASE AND HOLD HARMLESS THE PARKLAWN PIRANHAS SWIM/DIVE TEAM, PARKLAWN RECREATION ASSOCIATION, INC., PIRANHAS POWER BOOSTER CLUB, AND THEIR RESPECTIVE BOARD MEMBERS, COACHES, INSTRUCTORS, TEAM REPRESENTATIVES, VOLUNTEERS, PROPERTY MANAGER, EMPLOYEES AND AGENTS, AS WELL AS THE NORTHERN VIRGINIA SWIMMING LEAGUE AND ITS OFFICERS, DIRECTORS, AGENTS, EMPLOYEES OR OTHER REPRESENTATIVES FROM ANY LIABILITY OR 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 CLAIMS YOU MAY HAVE TO SEEK DAMAGES, WHETHER KNOWN OR UNKNOWN, FORESEEN OR UNFORESEEN, IN CONNECTION WITH EXPOSURE, INFECTION, AND/OR SPREAD OF COVID-19 RELATED TO PARTICIPATION IN PRACTICE OR COMPETITION. Teams and their pools have taken health and safety measures for all attending meets; however, we cannot guarantee that you will not become infected with COVID-19. All attending practices and meets must follow all posted instructions while in attendance. An inherent risk of exposure to COVID-19 exists in any public place where people are present. By attending, you acknowledge the contagious nature of COVID-19 and voluntarily assume all risks related to exposure to COVID19. By choosing to attend practices and meets, you agree to comply with all health and safety mandates and guidelines of the Commonwealth of Virginia, your local government, and the pool at which you are participating, either at your home pool or while competing at another NVSL-member pool.I agreeSwimmer/Diver Information:Swimmer 1:First Name: Last Name: Birthday: mm/dd/yySwimmer Allergies: Note any relevant allergies.Gender: MaleFemalePlease Choose Group:* *Please choose which group you would like to join:Bubbles (Level One) -- 5:30 - 6:00Tadpoles (Level Two) -- 6:00 - 6:30Guppies and Minnows (Levels 3 & 4) -- 6:30 - 7:00Please Choose Session(s):* *Please choose which session(s) you would like to join:9-Week Summer Session3-Week Session Starting June 223-Week Session Starting July 133-Week Session Starting August 3Swimmer 2:First Name: Last Name: Birthday: mm/dd/yyAllergies: Note any relevant allergies.Gender: MaleFemalePlease Choose Group:* Please choose which group you would like to join:Bubbles (Level One) -- 5:30 - 6:00Tadpoles (Level Two) -- 6:00 - 6:30Guppies and Minnows (Levels 3 & 4) -- 6:30 - 7:00Please Choose Session(s)* Please choose which session(s) you would like to join:*9-Week Summer Session3-Week Session Starting June 223-Week Session Starting July 133-Week Session Starting August 3Swimmer 3:First Name: Last Name: Birthday: mm/dd/yyAllergies: Note any relevant allergies.Gender: MaleFemalePlease Choose Group:* Please choose which Group you would like to join:Bubbles (Level One) -- 5:30 - 6:00Tadpoles (Level Two) -- 6:00 - 6:30Guppies and Minnows (Levels 3 & 4) -- 6:30 - 7:00Please Choose Session(s):* Please choose which session(s) you would like to join:9-Week Summer Session3-Week Session Starting June 223-Week Session Starting July 133-Week Session Starting August 3Swimmer 4:First Name: Last Name: Birthday: mm/dd/yyAllergies: Gender: MaleFemalePlease Choose Group:* Please choose which Group you would like to join:Bubbles (Level One) -- 5:30 - 6:00Tadpoles (Level Two) -- 6:00 - 6:30Guppies and Minnows (Levels 3 & 4) -- 6:30 - 7:00Please Choose Session(s):* Please choose which session(s) you would like to join:9-Week Summer Session3-Week Session Starting June 223-Week Session Starting July 133-Week Session Starting August 3Social 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: