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2015 Registration Form copy copy

Parent/Guardian Information

At least one parent/guardian registration is required.
New accounts will be sent an email confirmation message with instructions to setup a password.

Please indicate which parents will be volunteering this season. At least one parent/guardian is required to volunteer.

At least one parent/guardian email address must be provided.
Check the boxes to indicate which parent/guardians should receive team-wide emails.

First Name * Last Name * Email Address *
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Primary Phone Volunteer?

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Athlete Information

Enter the information for each athlete being registered below. At least one Athlete registration is required.

First Name * Preferred Name Middle Initial Last Name * Gender * Birth Date *
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Home Address

Assumption of Risk and Waiver of Liability

In consideration of the opportunity for our child (children) to join the 2015 Clinton County Barracudas Swim Team, we the undersigned parent/guardian, voluntarily assume, on behalf of our child (children), any risk of injury to him/her that may arise during practices and meets of the summer swim season. These risks include, but are not limited to, injuries due to racing dives, overexertion, competitive swimming or infection. We also agree to waive any right of action against the Clinton Swim and Tennis Club, the Miami Valley Swim Association, or the Clinton County Swim team, their officers, volunteers, employees or independent contractors, arising out of any injuries that may occur during our child’s swim team participation. 

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Enter your initials to indicate acceptance: *
Status of Membership in the Clinton Swim and Tennis Club

I am NOT a dues paying member of the Clinton Swim and Tennis Club. I acknowledge that I will incur an additional $60 fee  per swimmer to my membership as a result.  (Non dues paying members incur an additional fee of $60 per swimmer)