Transcription

1 Swimmer identification Name: First name : Birth date (AA/MM/JJ): Citizen card N o (Grants) : Address: Postal code: School board: Municipality: School: School level: Check the size of the T-Shirt (the sizes are not guaranteed) Youth medium: Adult small: Adult medium: Adult large: Parent identification Father: Name: Cellular phone: Home phone: Mother: Name: Cellular phone: Home phone: Check the desired option Tax receipt to the father: Tax receipt to the mother: Swimmer registration Check the desired group (visit our web site for the groups description) Evening civil groups Morning school and civil groups Morning school only Initiation pm: Dev 3 am: Dev 3 am: Pré-dév gr 1 pm: Dev 2 am: Dev 2 am: Pré-dév gr 2 pm: Dev 1 am: Dev 1 am: Dev 3 pm: GA am: GA am: Dev 2 pm:: Élite am: Élite am: Dev 1 pm: GA pm: Élite pm: Where did you hear about us?

2 Mandatory volunteering A check for $ 75 per family is requested at registration for volunteering. To get your money back, the family must accumulate 12 points by participating in the following activities: Timekeeper for 2 points, other official positions for 3 points, offer a clinic for 6 points, 6 points committee, follow a clinic and practice for the first time the function of official followed 6 points. A check for $ 25 is also requested per family to ensure your participation in the general meeting. It will be returned to your child's competition account after the meeting. Consent to be photographed I consent that my children will be photographed and I authorize Le Club de Natation Les Citadins and the school program to use the pictures of my children in promotion documents such as newspaper articles, local publicity, on the web site, on Facebook and on Instagram. Transportation consent By signing this form, I allow my children to be part of the swimming activities of Le Club de Natation Les Citadins and if necessary, I authorize him/her to travel in a vehicle driven by coaches or parent helpers. Payment information *** All check must be postdated and given at registration. Made out to Club de Natation Les Citadins At registration: 275$ non refundable+ $ 100 for volunteer fees and a refundable general meeting in your child's competition account. October 1, 2018: Full competition fees. November , February 1, 2019 and March 15, 2019 the balance in three parts ***See web site for fees, and details on schedule payments under Registration Section reserved to the Club Fixed administration costs : Competition fees: Balance : Parent meeting deposit: Volunteering deposit : Swimmer identification:

3 Name: Medical card N o : Medical profile: Medical file of the swimmer Expiration date: Medications: Allergies (specify): Epipen (Yes/No): Past serious injuries: The swimmer can administer its own medicine (Yes/No): Other: (prostheses, contact lenses etc...) : Code of conduct of the swimmer I am a member of Les Citadins Natation, as a swimmer: I promise to arrive on time with my equipment (bathing suit, goggles, and cap) ready to practice. I will pay attention to the advice given by my coach and I promise to work my hardest to attain the effort required to improve. The training may be difficult but I must try to reach my full potential. I will work to the best of my ability and talent I will be present at all practices and participate in all competitions I will treat all equipment with respect (kick boards, pull buoy, racing lanes and locker baskets). I will show my team spirit by wearing the team uniform I will respect my coach, my team mates, swimmer of other clubs and officials I will always speak respectfully in a non-threatening manner... I promise to abide the code of conduct of the Club. (If more than 11 years old or of the parents) parents I am a member of Les Citadins Natation, as a parent: Code of conduct of the parents I will be respectful at all times with the coaches, athletes, officials and other parents. I will communicate with the coach if the child must be absent more than three consecutive trainings. I will talk with the coach after the practice or make the arrangement for a meeting in person, by phone or by to discuss a problematic situation with my child. I will respect the final decision taken by the coaches concerning the placement of my child. I will let the coach take care of behavior problems and will not intervene on the pool deck. I will get Involve by following at least one new official training per year and to give of my time as a volunteer official at three competitions. I will communicate with the person responsible of volunteers the time I invested in training and volunteering to help with the system of points earned. I will notify the coach as soon as possible if the swimmer cannot attend the competition for which he is registered. I will encourage athletes swimmers to persevere, to excel and to be proud of them. I promise to abide the code of conduct of the Club. Return forms and full payment to: 1425, chemin du fleuve Les Cèdres J7T

4

5 Politique de Confidentialité, d accès à l information et protection des renseignements personnels Policy on the Confidentiality & Access to Information and the Protection of Personal Information FORMULAIRE DE CONSENTEMENT Veuillez lire soigneusement, remplir et signer ce formulaire. Un parent ou un tuteur légal doit signer pour les nageurs qui ont moins de 18 ans. Nom du club de natation : (le «club») Club de natation les Citadins Nom complet du nageur : (le «nageur») Numéro d inscription de Swimming Natation Canada : (numéro à 9 chiffres) Tous les nageurs ou leur parent ou tuteur légal doivent signer une copie de ce formulaire. Je consens par la présente à la collecte et à l utilisation de mon information personnelle telles que décrites ci-dessus. Ce formulaire sera conservé avec les dossiers du club mentionné ci-dessus jusqu à ce que le consentement soit retiré ou que l individu ou la famille cesse d être un membre de la Fédération de natation du Québec. En cas de transfert vers un autre club de la province, un nouveau formulaire de consentement devra être complété et conservé dans les dossiers de ce nouveau club. Les individus «indépendants/unattached» doivent compléter et envoyer ce formulaire de consentement directement à la Fédération de natation du Québec. Signature du nageur (si 18ans ou plus) OU Signature du parent ou tuteur (si 17ans ou moins) Nom en lettres moulées et lien avec le nageur (si signé par le tuteur) CONSENT FORM Please read carefully, fill out and sign this form. A parent or legal guardian must sign for swimmers less than 18 years old. Name of the swimming club : (the «club») Club de natation les Citadins Swimmer s full name : (the «swimmer») Swimming Natation Canada registration number : (9-digit number) All swimmers or their parent or legal guardian must sign a copy of this form. By the present, I consent to the collection and use of my personal information as described above. This consent form will be kept in the files of the above-mentioned club until such time as the consent is withdrawn or that the individual or the family are no longer members of the Quebec Swimming Federation. In the case of a transfer to another club in the province, a new consent form is to be completed and kept in the files of this new club. «Unattached» individuals must complete this consent form and send it directly to the Quebec Swimming Federation. Swimmer s Signature (if 18yrs or older) OR Parent or Guardian s Signature (if 17yrs or less) Date Name (printed) and relationship to swimmer (if signed by guardian) Tél. (jour) ( ) Tél. (soir) ( ) Courriel : Version 3 septembre 2010 «Ce formulaire est extrait du document du même titre pour fin de traduction.» «Veuillez consulter le document avant de signer ce formulaire.» Tel. (day) ( ) Tel. (eve.) ( ) Version : Sept-3-10 English version of the FNQ s «Formulaire de consentement» (page 5 of document «Politique de Confidentialité») Please consult the said document before signing this form.