Trumbull Pisces Swimming Association, Inc. September, July, 2017 Registration Agreement and Contract

Transcription

1 Trumbull Pisces Swimming Association, Inc. September, July, 2017 Registration Agreement and Contract I. REGISTRATION INFORMATION TRUMBULL RESIDENTS ONLY Please PRINT neatly Parent/Gardian (1) Name: Occupation: Cell Phone: Home Tel: Home Address: Relationship to Swimmer: Parent/Gardian (2) Name: Occupation: Cell Phone: Home Tel: Home Address: Relationship to Swimmer: SWIMMER #1 Name: M F Swimmer s Nickname: School: Grade Swimmer s Date of Birth: AGE: New: Returning Swimmer: (please check one) T-shirt Size ** GROUP ASSIGNMENT (Coach s use only) SWIMMER #2 Name: M F Swimmer s Nickname: School: Grade Swimmer s Date of Birth: AGE: New: Returning Swimmer: (please check one) T-shirt Size ** GROUP ASSIGNMENT (Coach's use only) SWIMMER #3 Name: M F Swimmer s Nickname: School Grade New: Returning Swimmer: (please check one) T-shirt Size** GROUP ASSIGNMENT (Coach s use Only) **T Shirt Sizes: Youth M, L; Adult Small, Med, Large, x-large

2 II Trumbull Pisces Swimming Association, Inc. (TP) CONTRACT The undersigned parent and the Trumbull Pisces Swimming Association Inc. (TP) agree as follows: 1. Fees (a) In consideration of the participation of the swimmer(s) in TP competitive swim program, the PARENT/GUARDIAN agrees to pay the dues for the Swimmer s practice level that are set forth on the attached Annual Fee schedule. Payment shall be made either (1) on an annual basis (on or before September 1 st ) with a 5 % discount or ( 2 ) on payment plan with the first fee payment due before September 1 (September 21 st for New Swimmers after Tryouts) and the 2 nd and final fee paid by 31 st. Fees may be prepaid at any time. If you choose to pay other than in full, you must provide a valid Credit Card number. If a check is returned or credit card denied there is a $50 penalty. There is a credit card fee. (b) If the Swimmer quits or leaves the swim program or is unable to continue participation in the program after FOUR (4) weeks, the swimmer s parent/guardian(s) is obligated to pay any remainder of the annual swim dues outstanding. If swimmer withdraws after 4 weeks, NO FEES are refundable EXCEPT in the case of a medical reason preventing the swimmer from returning to swimming and must be accompanied by a licensed physician s written letter. (c) If there is financial hardship, the parent must apply to the TP Board of Directors for financial assistance based on need. Support statements such as income tax forms may be requested as well as other information to support the request. 2. Suspension (d) Any late payment fee will be charged a $50 penalty per late payment, after a 10 calendar day late period. Any fee payment on the payment plan must be made by the date of the month in which it is due or the swimmer will be suspended from further participation in all TP activities, including but not limited to practice and meets until payments are current. (e) If a Parent/Guardian becomes delinquent in payment of fees because of financial hardship, he/she may apply to the Board for a waiver of fees and suspension. 3. Swim Group Assignments (f) The assignment of the Swimmer(s) to a practice group shall be the decision of the coaching staff. An assignment may be modified during the swim year if the coaching staff believes a different practice group would be more appropriate for the Swimmer. If the Swimmer is transferred to a different practice group by the coaching staff, the difference in fees between the two practice group levels shall be paid within 10 calendar days of the group movement in order to avoid any late charges. 4. Release of Liability (g) Parent/Guardian hereby releases TP, officers, directors and volunteers and any facility used by TP from any liability arising out of any injury to the Swimmer(s) which may occur while the Swimmer(s) is/are participating in the TP swim program, but not limited to, practices, meets, travel trips and other team activities, or while the Swimmer (s) is/are using facilities owned, leased or used by TP. 5. Fundraising/Swim Meets (h) Revenue from fund raising constitutes a significant part of the TP operating budget. In any fund raising project designated by the Board of Directors as one in which participation is mandatory. Parent/Guardian agrees that at least one adult family member shall participate as a volunteer. I/we understand that the Trumbull Pisces Swim team (TP) is a volunteer organization and that the team will succeed if everyone cooperates and helps out with their assigned duties (mostly timing). I/we agree to support the team by working at swim meets attended by my/our swimmers(s). If I/we fail to fulfill the timing duties, I/we agree to pay a fine of $50 per missed duty. Page 2 of 11 Parent or Guardian Signature Date

3 Trumbull Pisces (TP) MEDICAL INFORMATION & EMERGENCY RELEASE (one form per swimmer) Please print neatly Swimmer s Name: Parent/Guardian s Names: Home Phone: Work phone Cell Phone: 1. Please list any pertinent health or medical information and instructions or special problems (allergies, asthmas, prescriptions, etc. please attach a separate sheet, if necessary): 2. Other than a parent/guardian, please indicate those individuals (in order of preference) that you would like the coaches to contact should there be an emergency involving your child: Name Name Name 3. Swimmer s Doctor: phone number_ cell 4. Swimmer s Dentist phone number: I/we hereby give our permission for to participate in practice and travel with the TP to local and out of town meets throughout the swim season. Although I/we expect all reasonable safety procedures to be followed, I/we will not hold the coaches of TP or any volunteer working with the group personally liable for any accident which may occur. In case of a minor emergency (cuts, scratches, headache, etc.), I/we give permission to the coaches to treat these as they deem necessary. In the event of a more serious emergency, I/we give permission for it to be handled in the best manner as determined by the coaches, until I/we can be contacted. TO THE ATTENDING PHYSICIAN OR HOSPITAL: Permission is hereby granted for you at the discretion of the coaches of TP to perform whatever care is necessary for the welfare of my child until such time as you are able to reach me/us personally. INSURANCE INFORMATION: (must be complete) Subscriber s Name (parent): Insurance Company name: Insurance ID # Insurance Group # Insurance Coverage (i.e. medical, dental): Insurance authorization telephone number: Preferred local hospital: cell cell Page 3 of 11 Parent/Guardian Signature Date

4 TRUMBULL PISCES SWIMMING ASSOCIATION, INC. TEAM RULES The Trumbull Pisces (TP) goal is to develop the highest level of competitive excellence possible for all swimmers, while simultaneously encouraging spirit, honesty, team pride, personal commitment and individual growth. In order to achieve our mission and assure the safety of our swimmers at practice and meets, we will strictly enforce the following rules and guidelines. The following rules should be read, fully understood by parent(s)/guardian(s) and swimmer(s) and signed, where indicated. Te am Rules 1. Swimmers are to be dropped off no sooner than 15 minutes before practice and to be picked up immediately at the end of the practice session. 2. Swimmers are to go directly to the pool area. All swimmers personal belongings and swim bags are to be kept on the pool deck during practice. Nothing should be kept in the locker room. 3. Running or disorderly behavior on deck, in the locker rooms and anywhere else on the premises will not be tolerated. 4. Swimmers may enter the pool area ONLY after the coach has arrived. 5. Swimmers are expected to be on deck and ready to work at the designated times for practice sessions and for warm ups at the meets; team swim caps and team suits are to be worn at all meets. 6. If you are going to be absent for more than 1 day, please notify the coach via . Coaches addresses are on the website. 7. Use of the entire Hillcrest pool facility is to be treated as a privilege. The privilege can be taken away from us. Therefore, it is important that every swimmer make every effort to treat the building and pool area with respect and care. Any behavior as defacing or damaging to this facility will not be tolerated and will result in immediate termination from the team with forfeiture of all fees. 8. Absolutely NO FOOD is allowed in the locker room or on the pool deck during practices. 9. Swimmers are expected to respect the privacy of others that may be changing in the locker rooms. No one is to touch the belongings of a team member or others using the locker rooms. Absolutely NO CELL PHONES can be used in the locker rooms. 10. Swimming equipment is to be properly maintained and returned to its rightful place when it is no longer being used. 11. The team is organized by age and ability levels. A swimmer will practice with her/his practice group according to the scheduled times posted on the website. 12. Parents are not allowed on deck during practices except Fridays. Parents are not allowed to interrupt practice and/or swim meets to discuss an individual matter with any coach. Any concerns or problems should be brought to the Coach s attention via and a meeting will be arranged at a mutually convenient time. Swimmer (1) Signature Swimmer (2) Signature: Swimmer (3) Signature: Parent/Guardian Signature: Print Swimmer (1) Name Print Swimmer (2) Name Print Swimmer (3) Name Page 4 of 11

5 At Meets : TRUMBULL PISCES SWIM TEAM CODE OF CONDUCT The Trumbull Pisces Code of Conduct is to ensure the positive experience of all swimmers and continue providing a fun, safe and positive learning environment for all of the participants and spectators. All swim team members, as well as their parents and/or guardians, of the Trumbull Pisces Swim Team must follow the Code of Conduct as listed below. Failure to comply will result in immediate disciplinary action determined by the guidelines below. As a participant in the Trumbull Pisces Swim Team program, I agree to the following: I will act in a sportsmanlike manner towards my teammates and fellow competitors. I will understand and practice proper lane etiquette and to refrain from behavior that will inhibit the progress of my fellow swimmers. I will wait in water for races to finish. I will shake hands with competitors after each race. I will listen to and follow any other rules posted at the facility hosting the meet. I will support my teammates I will NOT USE ANY ELECTRONICS on Deck At Practice and Meets : I will be respectful and supportive of my teammates whenever and wherever possible, on and off the pool deck. I will refrain from any/all hurtful physical behaviors including but not limited to pinching, hitting, kicking, fighting, punching, etc. I will refrain from any/all hurtful verbal behaviors including but not limited to teasing, name calling, ignoring, spreading rumors, etc. I will not use inappropriate language or gestures. I will not use Illegal drugs, alcohol or tobacco. I will be respectful towards all coaches, officials, and meet staff at all times. I will not talk when coaches are talking, I will listen with eyes and ears, answer respectfully when spoken to, and follow directions/instructions. I will bring all necessary equipment, supplies, and swim uniform to each practice/meet and be responsible for my belongings. I will arrive on time to all meets and practices. I will notify a coach of any absent and/or if I need to leave practice early. I will have a positive attitude, always do my best and I will have FUN! As a parent or guardian of a participant in Trumbull Pisces Swim Team program, I agree to the following: I will act in a sportsmanlike manner towards members of the team, their family members and fellow competitors at meets and practices. I will not use inappropriate language or gestures. I will refrain from any/all hurtful behaviors including but not limited to pinching, hitting, kicking, fighting, etc. I will refrain from any/all hurtful behaviors including but not limited to teasing, name calling, ignoring, spreading rumors, etc. If a swimmer (or parent) feels that he/she is not being treated in accordance with the above expectations, they should ask to schedule a meeting with the Head Coach to address their concerns. Page 5 of 11

6 Trumbull Pisces Code of Conduct - continued If any Coach finds that a swimmer or parent/guardian is in violation with the above Code of Conduct, discipline will be handled in the following manner: 1 st Offense Verbal warning to the swimmer(s) or parent/guardian and meeting with parents/ guardians if it s a swimmer. 2 nd Offense Written warning. If swimmer - notification to parents/guardians and immediate removal from the current practice or meet at a minimum. Parent/guardian will be asked to leave the practice area or swim meet. Swimmer/parent/guardian may be suspended for additional practices/meets as warranted by situation. 3rd Offense Dismissal from the team for the remainder of the season, and possibly indefinitely if merited NO refunds will be issued. Swimmer: I have read and agree to act in accordance with the above Code of Conduct expectations and guidelines. I understand the consequences of not following the Code of Conduct. Swimmer s Name: (Printed) Swimmer s Signatures: Swimmer s Name: (Printed) Swimmer s Signatures: Swimmer s Name (Printed) Swimmer s Signatures: Parent/Guardian: I have read and understand the above Code of Conduct and agree to act in accordance with the above Code of Conduct expectations and guidelines. I understand the consequences that will occur as a result of my child or myself not following the Code of Conduct. Parent s Name (Printed) Parent s Signatures: Page 6 of 11

7 INFORMED CONSENT AND RELEASE OF LIABILITY (Please complete ONE form per swimmer) Participation in all sports requires an acceptance of possible injury. The athlete and parent/guardian must be aware that by participating in sports you are in a position to make an informed decision for participation in physical fitness activities and competitive sports. In giving your consent, you are aware that the risk of injury may be severe, including the risk of fractures, brain injuries, paralysis or even death. We hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE The Trumbull Pisces Swimming Association, Inc. (TP), The Trumbull Department of Parks and Recreation and/or The Town of Trumbull and any of their employees, servants or agents and to hold harmless from and against any and ALL LIABILITY, FOR ANY AND ALL LOSS OR DAMAGE, AND ANY CLAIM OR DEMANDS THEREFOR ON ACCOUNT OF INJURY TO THE PERSON ARISING OUT OF OR RELATED TO ANY EVENT(S), WHETHER CAUSED BY THE NEGLIGENCE OF The Trumbull Pisces Swimming Association, Inc. (TP), The Trumbull Department of Parks and Recreation a n d / o r T h e T o w n o f T r u m b u l l O R O T H E R W I S E, o u r s w i m m e r (print name) may suffer, or to our heirs, assigns or personal representatives for personal injury. This shall include, but is not limited to, injury, death or sickness occurring in connection with or aggravated by his/ her/their participation in the Trumbull Pisces Swim program and any consequences resulting directly or indirectly from that program. I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. Parent/Guardian Signature Date Print Name: Page 7 of 11

8 TRUMBULL PISCES SWIMMING ASSN, INC. (TP) PHOTO RELEASE Trumbull Pisces Swimming Association Pisces occasionally uses photographs of swimmers for its website and for the newspaper. We ask for your permission to use any photos taken of your swimmer(s) for promotional purposes to benefit Pisces visibility in the community. I,, parent/guardian of Pisces swimmer(s) allow for representatives of the Pisces the irrevocable right and unrestricted permission to use and publish photographs or video images of me, or in which I may be included, for any purpose authorized by Pisces, including but not limited to: website use, editorial publications, and advertising use. I understand that the circulation of such materials could be town wide or on the internet and that there will be no compensation to me for this use. Furthermore, I understand that I will not be given the opportunity to inspect or approve the finished products that may be used in connection therewith. In granting this permission to Pisces representatives, I am fully and without limitation releasing it from any liability that may arise from the use of the images. I further agree to the inclusion of name(s). Parent/guardian name printed Parent/guardian signature Swimmer s name(s) Swimmer s name(s) Swimmer s name(s) Date Page 8 of 11

9 Trumbull Pisces Swimming Association, Inc. Proof of Review Form I hereby affirm that I have read and understand the Trumbull Pisces Registration application, Contract, Medical Information and Emergency Release, Team Rules, the Code of Conduct, Informed Consent and Release of Liability, Photo Release form, Annual Registration Fee Schedule and the Trumbull Pisces Handbook and will abide by all of the items referenced therein. Parent/Guardian signature: Print Parent/Guardian Name: Swimmer (1) Swimmer s signature: Print Swimmer s name: Swimmer (2) Swimmer s signature: Print Swimmer s name: Swimmer (3) Swimmer s signature: Print Swimmer s name: Page 9 of 11

10 Trumbull Pisces Swimming Association, Inc. ANNUAL FEE SCHEDULE September, 2016 July, 2017 Black/Yellow Age Group Seniors High School Girls* $1,545 $1,775 $2,245 $1,875 Boys* $1,530 $1,760 $2,230 $1,810 *the difference in boys and girls prices are based upon the cost difference of suits 1) Every swimmer will receive a fitted Speedo Trumbull Pisces Competition swim suit to be worn at swim meets. The cost of the suits are NON REFUNDABLE. Additional Suits can be purchased in advance at the cost of: Girls $66.00 Boys $ ) 5% Annual Discount ONLY valid if ANNUAL FEE IS PAID IN FULL BY 9/1/2016 3) An Additional 5% discount for the 2 nd and 3 rd sibling (either full annual payment or 2 payment plan) PAYMENT SCHEDULE 60% of the FULL fee for each swim group by September 1 st (September 21 st for new swimmers at Pisces Tryouts) 40% balance for each swim is due January 31 st. The credit card used for initial payment will be automatically charged unless otherwise notified. Checks payable to: Trumbull Pisces Mailed to: PO Box 245 Tr umbull, CT Payment Type (please check one) MC VISA_ DISCOVER Check # INITIAL AMOUNT PAID (if paying in 2 payments) $ NAME (as appears on CC) Card # Signatures Expiration - Overdue payment of more than 10 Calendar days (from due date) will incur a $50 late fee. - Credit Card payments will result in a 3 % credit card fee - CURRENT AND VALID CREDIT CARD number, expiration, and 3 digit security code is REQUIRED for any PARTIAL PAYMENT by Credit Card. The registration fees are INCLUSIVE of the program fee, USA registration fee, Team swim cap, Speedo Swim Suit and team t-shirt, meet fees except for those meets that are Coach s invitational meets. Age Group meets and Zone meet fees are extra. These meet fees, if your swimmer participates are extra and will be billed separately.

11 Check List for Trumbull Pisces (TP) Registration Paperwork please include ALL of the following documents: FAMILY NAME: FOR BOARD USE ONLY: Trumbull Pisces Registration Application Trumbull Pisces Contract Trumbull Pisces Medical Information and Emergency Release (one for each swimmer) Trumbull Pisces Team Rules Trumbull Pisces Personal Code of conduct form (2 pages) Trumbull Pisces Informed Consent and Release of Liability (one for each swimmer) Trumbull Pisces Photo Release Form (for new swimmers or any current swimmerone who has not signed one) Trumbull Pisces Proof of Review Form Trumbull Pisces Annual Fee Schedule and payment options please review carefully for current credit card information. CT SWIM Application ( ) FOR NEW SWIMMERS ONLY: Copy of Birth Certificate (required for new swimmers only) Copy of Trumbull Resident ID/Utility bill (required for new swimmers only) For all swimmers: Please check the appropriate payment information Payment Method: Check Credit Card Full payment Two (2) Payment plan Please write the AMOUNT paid with the initial application with any applicable discounts $ May we include your phone number(s) and (s) in a parent Roster? YES NO Please indicate how you wish to help the team through volunteering? Team liaison, fundraising, publicity, board position, if available, other (please specify). Page 11 of 11