Member Forms Checklist

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1 Member Forms Checklist Membership Application Aquatic Waiver and Release of Liability Parent Volunteer Form USA Swimming Form (New Members Only)

2 WELCOME Welcome to the Polar Bears of Los Gatos, a USA Swimming Team. We are a non-profit organization offering competitive swim programs for the novice through national caliber athlete. By choosing Polar Bears of Los Gatos you have joined one of the newest, and soon to be one of the best teams in the area. Our swimmers have achieved success at the local, regional, and national levels. The sport of swimming is a good, clean, wholesome sport full of fun. We train our swimmers to associate enjoyment with their time spent in the pool with the Polar Bears, and hope we are starting the swimmer on a lifelong journey of health and fitness. One of the greatest benefits in participating with USA Swimming and the Polar Bears are the life skills that your swimmer will develop through their participation. Some of these skills are dedication, perseverance, sportsmanship, time management, and self-discipline, just to name a few. Swimmers go on to be very successful in life, using the skills gained from their swimming experience. The Polar Bears of Los Gatos coaching staff is dedicated to the improvement and success of our team as a whole and of each individual swimmer. Our coaches work very hard to provide an atmosphere where every swimmer can strive for success and achieve their highest potential. We are confident that you will enjoy the Polar Bear experience. Nicholas Jufiar Head Coach

3 Membership Information The Polar Bears of Los Gatos is a non profit, community based, USA Swimming Member Organization. Our mission is to provide high quality swim instruction for youths and adults. We offer a one-week free trial to any swimmer interested in joining the Team. All swimmers are required to pay their monthly dues in a timely fashion in order to be in good standing and participate with the team. Membership fees are as follows: Annual Member Fee: New members $250.00/Returning Members $200. Annual USA Registration Fee: $73.00 (paid upon joining Club) Inactive Fee $75.00 (Required 30 day written notice) Monthly Fees Based on Practice Group: Cubs $75.00 Instructional Group 1: $ Instructional Group 2: $ Developmental Group 1: $ Developmental Group 2: $ Advanced Age Group: $ Varsity Group $ Pre Senior Group: $ Senior Group: $ Monthly swim dues are the primary source of income for the team. Because of this our Club is dependant upon regular and timely receipt of these funds, it is essential that the fees be paid on time each month. The fees are based on year round participation of each SBLG and paid electronically via the LG-Saratoga Recreation Department. Annual Fees and USA Swimming Fees will be paid by Check to SBLG. If late payments become repetitive, swimmers may not be permitted to continue their practice session until the fee is paid in full. Dues will not be pro-rated and must be paid in full for any month during which the swimmer(s) swims with the Team, even if only once. If a swimmer will not be attending practice or meets for a month or more, Polar Bears of Los Gatos offers an inactive status, with 30 day advance written notice. Please send a note or to Head Coach Nick Jufiar A $75/ per month inactive fee can be paid in lieu of dues when a swimmer will not be swimming for a month (no discounts for multiple swimmers on inactive status). If dues or inactive payment is delinquent for more than one month, you will be removed from the roster and will have to pay the Annual registration fee of $ upon re-joining, even if paid earlier in the same year. Please note that 30 days written notice is required to end your financial obligation upon leaving the team.

4 Team Equipment The Team asks that all swimmers get the necessary equipment for their group. All equipment serves a specific need that will help to improve the swimmers overall swimming performance. In addition all Girls will be asked to wear Caps and Boys wear jammers or briefs at practice. Practice Group: Instructional Age Group / Developmental Age Group/Cubs Mesh Bag to keep practice equipment in Kickboard small/hard Fins (rubber flexible no strap) by Speedo, Tritan, TYR, or Dolphino Water Bottle Center Mounted Snorkel by Finis (Developmental Group Only) Advanced Age Group / Pre-Senior Mesh Bag to keep practice equipment in Kickboard Fins by Speedo, Tritan, or Dolphino Pull Buoy Paddles Strokemaker Center Mount Snorkel by Finis Water Bottle Senior Mesh Bag Kickboard Fins by Speedo, Tritan, or Dolphino Zoomers by Finis Pull Buoy Paddles Strokemaker Center Mount Snorkel by Finis Water Bottle Swimmers may participate in dry land on specific days in their practice group. Swimmers will be asked to wear PE type clothing with running shoes for dry land sessions. Swimmers are asked to dress appropriately for the weather conditions. Team Suits and all other equipment can be purchased at the Norcal Swim Shop in Santa Clara. The address is: 5124 Stevens Creek Blvd. San Jose, CA Tel :(408)

5 Parent Volunteer Form Supporting your child in swimming is a fun and very rewarding experience. Parents participation is needed for timing at the meets, helping at fundraisers, organizing social events, and becoming a USA Swimming Certified Official. Whatever your role may be, your child s experience with our team has a lot to do with positive family support. Please initial each requirement and turn in the sheet with your packet. Polar Bears of Los Gatos hosted swim meets GATO may choose to run a swim meet or swim meets during the year. These meets are a substantial portion of our fundraising efforts each year. They are also part of our responsibility to support the sport, and our Zone. Each family will be given a required number of shifts to work at Polar Bear hosted meets. Timing at meets Each team that attends a meet is expected to provide timers based on the number of swimmers that they bring to the meet. Each family is expected to time at least one shift during the meet. Parents can sign-up online at the Polar Bears of Los Gatos website Just go to the event and click on the Job Sign-up tab. Social and Fundraising events Each family is expected to assist in either a team social event or a fundraising event during the course of the year. Inactive Status If a swimmer will not be attending practice or meets for a month or more, we offer an inactive status, with 30 days advance written notice. A $75/ per month inactive fee can be paid in lieu of dues when a swimmer will not be swimming for a month. Volunteer Service Agreement Each family are asked to help volunteer at all events that SBLG hosts or their swimmer attends.. At the end of your trial week, turn in the following items to your coach. Membership Application Aquatic Waiver and Release of Liability Parent Volunteer Form USA Swimming Form(New Members Only)

6 MEMBER INFORMATION Swimmer Name (First, Last, and Middle): DOB: Age: Gender M/F: T-shirt size: Group Level: Swimmer Name (First, Last, and Middle): DOB: Age: Gender M/F: T-shirt size: Group Level Father s Name: Cell # Mother s Name: Cell# Mailing Address: City: Zip code: Home Phone # Emergency Contact: Phone # Any Medical Information we may need to know? Insurance Carrier: Policy # Doctor s Name: Phone # MEMBERSHIP In consideration of the privilege of membership to the Polar Bears of Los Gatos, we the parent(s) / guardian(s) of the above swimmer(s) hereby hold Polar Bears of Los Gatos, its parents, and employees, free and harmless from any liability for injuries or damages they, or our swimmer(s) may incur as a result of our swimmer(s) participation in team events and activities, including practice sessions, and we assume the team s responsibility for the same. Also, as parent(s) / guardian(s) of the above swimmer(s) we agree to payment of swim team fees, and club fee as described above or as amended by the Polar Bears of Los Gatos. Parent Name and Signature: Date: EMERGENCY In case of emergency, I understand every attempt will be made to reach our family physician. If he/she is not available, I give my permission to use the closet medical facility. I also authorize the appointed team representative to approve medical or dental treatment for my child in my absence. Parent Name and Signature: Date:

7 INITIAL PAYMENT $75.00 Cubs $ Instructional 1 Swimmer $ Instructional 2 Swimmer $ Developmental 1 Swimmer $ Developmental 2 Swimmer $ Advanced Swimmer $ Varsity Group $ Pre-Senior Swimmer $ Senior Swimmer $73.00 USA Swimming Fee $ New Member/$ Returning Members Club Fee/$50(Cubs Only) Total Polar Bears of Los Gatos WAIVER / RELEASE OF LIABILITY I,, the enrolled participant and / or parent / guardian of the participant agree and understand that swimming is a HAZARDOUS activity. I recognize that there are risks inherent in the sport of swimming, including but not limited to, paralyzing injuries and death. The named participant agrees to participate with Polar Bears of Los Gatos and herby agrees to indemnify and hold harmless the Polar Bears of Los Gatos, its coaches, officers, directors, agents, and employees against any liability resulting from any injury while participating in Aquatic Programming with Polar Bears of Los Gatos. The participant also agrees to indemnify Polar Bears of Los Gatos for any damages incurred from any claims, demand, action or cause of action by the participant. The participant authorizes any representative of Polar Bears of Los Gatos to have the participant treated in any medical emergency during their participation with Polar Bears of Los Gatos. Further, the participant and/or parent/guardian agree to pay all costs associated with medical care and transportation for the participant. I have noted on this form any medical/health problems of which the staff should be aware. I HAVE CAREFULLY READ THE ABOVE LIABILITY RELEASE AND SIGNED IT WITH FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE. Signature: Date:

8 Team Gear Order Form ITEM DESCRIPTION PRICE COLOR SIZE (CIRCLE) QTY Tshirt Logo centered on front $14.00 Royal Youth: S, M, L Adult: S, M, L, XL Ladies fit tshirt Logo centered on front $15.00 Royal Ladies: S, M, L, XL Tanktop Logo centered on front $17.00 Royal Adult: S, M, L, XL Ladies fit tanktop Logo centered on front $17.00 Royal Ladies: XS, S, M, L, XL Hooded sweatshirt- Logo centered on front $30.00 Royal Youth: S, M, L Youth Zipped sweatshirt- Logo centered on back $40.00 Royal Youth: S, M, L Youth Hooded sweatshirt - Logo centered on front $30.00 Royal Adult: XS, S, M, L, XL Adult Zipped sweatshirt - Logo centered on back $40.00 Royal Adult: XS, S, M, L, XL Adult Sport Tek ¼ Zip Logo centered on back $40.00 Royal Adult: XS, S, M, L, XL Sweatshirt - Adult Jerzees ¼ Zip Sweatshirt - Youth Logo centered on back $35.00 Royal Youth: S, M, L Flannel pants - unisex Los Gatos Polar Bears down leg $39.00 Royal/silver /white Youth: S, M, L Adult: S, M, L, XL Knit skull cap Logo embroidered on $14.00 Black One size front Flexfit baseball cap Logo embroidered on $24.00 Royal S-M, L-XL front Team Parka Los Gatos on back. Indicate name to be embroidered on parka: $ Tax Royal blue, black fleece inside XS, S, M, L, XL, XXL L-L, XL-L, XXL-L Add $10 for Long sizes, XXL, and XXXL. Team swim cap Silicone $15.00 One size Latex $5.00 One size Order Total PAYMENT MUST BE RECEIVED UPON PLACING ORDER. Make checks payable to SBLG. Swimmer s Name: Phone: Contact Coach Nick, or

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