Swim Lessons Registration Page

Swim Lessons Registration Form

Please Acknowledge:* *
Our family is a Parklawn MemberYesNo
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.

Parent Information

Father'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 CodeCountry

Mother'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 CodeCountry

Other 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 CodeCountry

Primary Contact: Which adult should be the primary contact for this swimmer?

Participation 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 AGREE THAT MY FAMILY AND MY CHILD/CHILDREN WILL ABIDE BY THE PARKLAWN PIRANHAS CODE OF CONDUCT.I agree
COVID-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 agree

Verification

Please enter any two digits *Example: 12
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Swim Lessons Registration Form

Parent Information

Swimmer/Diver Information:

Swimmer 1:

Swimmer 2:

Swimmer 3:

Swimmer 4:

Verification