Rockwood Swim Summer College Registration ADDRESS: Rockwood Swim Club 1401 Froesel Drive Ellisville, MO 63011 OFFICE HOURS: 8:00 am 4:30 pm OFFICE TELEPHONE: (636) 891-6638 OFFICE FAX: (636) 891-8844 2016 Summer College Registration It s time to register for the Rockwood summer swim session. The summer swim session begins May 9, 2016 and ends August 5, 2016. Attached is the registration form for this summer. Return registrations to the RSC Office by Friday, May 6, 2016. All accounts must be paid in full at this time. No one will be permitted to register if they owe fees from a previous session. NOTE: Any registrations received after May 31, 2016 will be charged a $10.00 late fee. Fee Schedule All swimmers must have a valid USA card. If you have not already purchased one, the fee is $60.00. If you are transferring from another USA club, there is a $1.00 transfer fee. There is a $70.00 administrative fee per family. SESSION FEES: Additional Fees-- (added per session) USA Card Admin. Fee $60.00 per $70.00 per swimmer family The swim fee schedule is set by the Rockwood School District and is as follows: Former members of RSCA $200.00* All others $250.00* *Plus fees listed above! If you wish to participate in any meets, you MUST establish a Meet Escrow Account with a minimum of $50.00 per meet selected. Swimmers WILL NOT be entered in meets if there is not adequate money in their escrow accounts on the Last Change Date for any given meet. All new families must sign a Rockwood School District insurance waiver listing each participating swimmer in the family. Prorated fees are not offered during the summer session.
Please complete one form per swimmer (please print). ROCKWOOD SWIM CLUB REGISTRATION FORM College Swimmers Swimmer s Name ( ) Last Name First Name Middle Initial Preferred Name Address: Street City State Zip M/F Birthdate(mm/dd/yy) / / Home phone ( ) Best Family Email address * *Important for team news and notification of schedule changes Father s Name Mother s Name Employer Employer Job Title Job Title Work/Cell Phone Work/Cell Phone Names of siblings also enrolling on other forms Waiver on reverse of this form and separate medical consent form MUST also be completed! - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Include two checks for fees, as follows: Former members of RSCA $200.00 OR All others $250.00 Make this check payable to Rockwood School District. PLUS USA Swimming Membership $ 60.00 (if not already purchased) Administration Fee $ 70.00 TOTAL: $130.00 Make this check payable to Rockwood Swim Club (Add a minimum of $50 for escrow to this check if planning to participate in meets!) Outstanding balances MUST be paid at this time or registration is void.
WAIVER, RELEASE OF LIABILITY AND HOLD HARMLESS AGREEMENT In return for being accepted into the offered by the Community Education Department of the Rockwood R-VI School District ( the Program ), I: 1. Acknowledge that I understand the nature of the Program, and that I am qualified to participate in the Program. I further agree that if at any time I believe conditions to be unsafe with respect to my physical condition, the equipment, or facilities, I will immediately discontinue participation in the Program. 2. Further acknowledge that the program involves the risk of serious bodily injury (including the possibility of permanent disability, paralysis, or death), which may be caused by (a) my own actions or inactions, (b) the actions or inactions of others participating in the Program, (c) the condition of the equipment and/or facilities at which the Program is located, or (d) the actions or inactions of the entities and persons identified below; and I fully accept and assume all such risk and all responsibility for losses, costs, and damages I may incur as a result of my participation in the Program. 3. Accordingly, I hereby release the Rockwood R-VI School District, together with its directors, officers, employees, volunteers, and agents from all liability, claims, demands, losses, or damages arising out of my participation in the Program; and I further agree that if, despite this release and waiver of liability agreement I, or anyone on my behalf, makes a claim released in this agreement, I will indemnify and hold harmless each entity and person released herein from any and all litigation expenses, attorney fees, loss, liability, damage, or cost they may incur as the result of such claim. I have read this agreement, fully understand its terms, and have voluntarily entered into this agreement of my own free will based only upon the terms and conditions included herein. Printed Name of Participant Address (Street) (City) (State) (Zip) Telephone Number (work) (home) (cellular optional) PARTICIPANT S SIGNATURE (only if age 18 or over) (if under 18, see Minor Release) Date
ROCKWOOD SWIM CLUB CONSENT FOR MEDICAL TREATMENT Please complete one form per swimmer. SWIMMER INFORAMTION Swimmer s Last Name: First: MI Address: City: State: Zip: M/F: Birthdate: School: Grade: Father/Guardian: Secondary Phone: Mother/Guardian: Secondary Phone: Primary Phone: Email: Primary Phone: Email: MEDICAL INFORMATION Physician: Medications currently being taken: Allergies: Phone: Does swimmer wear contacts/glasses: Yes No Has any physician ever recommended that there be any limits placed on participation in competitive sports? Yes No Please list any other useful information or health concerns: Insurance Company: Coverage Type: HMO PPO NA Insurance Carrier: Mom Dad Other: Policy Number: I hereby give my consent for the student to represent Rockwood Swim Club in activities, except those stated on medical form by examiner. I also give my consent for him/her to accompany the team as a member of its out-of-town trips and will not hold the school district responsible in case of accident or injury. I also give consent and authorization to the Rockwood Swim Club to obtain, through a physician of its choice, such medical care as is necessary for the welfare of the student, if he/she is injured in the course of a club activity. Signature: Date:
TEAM CODE OF CONDUCT ROCKWOOD SWIM CLUB As a Rockwood Swim Club athlete, I recognize and agree to conform to this Code of Conduct at all times when representing the Rockwood Swim Club. This includes all activities during regularly scheduled practice time, at swim meets, or other Swim Club functions. 1. The possession or use of alcohol, tobacco products or controlled substances by any athlete is prohibited. 2. Team members will attend all team functions, including meetings and competitions unless excused by the appropriate coach. 3. Athletes will not leave a meet or scratch an event without the approval of the appropriate staff member. 4. Team members will refrain from any inappropriate or illegal behavior, verbal or non-verbal that would detract from a positive image of Rockwood Swim Club and USA Swimming. This includes all school district property, hotel, host facility, vans and or bus transportation. 5. Athletes will display proper respect and sportsmanship towards coaches, officials, administrators, fellow competitors and the public. Bullying is strictly prohibited. Regarding out of town or overnight team travel, the following code of conduct will apply to athletes in addition to those items listed above: 1. A nightly curfew will be established by the coaching staff and will be adhered to each day of travel. 2. To ensure the propriety of the athletes and to protect the staff, there will be NO male athletes in female athlete rooms and NO female athletes in male athlete s rooms UNLESS the door is unlocked and open at all times. Those athletes staying with their parents are instructed to follow the same rules regarding non-family members. All athletes and parents will read and sign this Code of Conduct IMPLEMENTATION 1. All athletes will read and sign this Code. 2. Any Swim Club athlete who, after being given an opportunity to present his/her version of an alleged violation with this code of conduct, shall be subject to disciplinary action up to and including the following: a. Suspension from regular practice sessions b. Removal of athlete from competition or from the club c. If a violation occurs while the Club is on an out of town or overnight travel, the athlete will be immediately sent home at the expense of the athlete and/or family. Strict compliance is mandatory. All controlled and any other illegal substances will be turned over to the local law enforcement agency. 3. An athlete s family will be notified as soon as possible if there is a violation of Code of Conduct. A meeting will be scheduled with the appropriate staff, athlete and parent for continued infractions, as needed. Persons present while any violation occurs must leave immediately or be considered and reprimanded as a participant by choice. Signature of Athlete: Date: Signature of Parent: Date:
RSCA SUMMER PRACTICE SCHEDULE Starting May 31, 2016 (Please make sure to follow your coach on Twitter for changes due to weather) BRONZE SUNDAY MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SAT. CMS-50M LAFAYETTE CMS-50M LAFY CMS-50M CMS-50M 10:30-12:00 PM 5-6:30 PM 10:30-12 5-6:30 PM 5-6:30 PM 10:30-12 PM SILVER LAFAYETTE CMS-50M LAFAYETTE CMS-50M CMS-50M CMS-INDOOR 4:30-5:50 PM 5-6:30 PM 6:10-7:30 PM 5-6:30 PM 10:50-12:30 PM 12:45-2:15 PM SENIOR PREP CMS-50M CMS-50M CMS-50M CMS-50M CMS-50M 5-6:30 PM 10-12 PM 5-6:30 PM 10-12 PM 11-12:30 PM GOLD LAFAYETTE CMS-50M LAFAYETTE CMS-50M CMS-50M CMS-50M 6:00-7:30 PM 5:00-6:45 PM 4:30-6:00 PM 5:00-6:45 PM 10:50-12:30 PM 10:50-12:30 PM SENIOR CMS-50M CMS-50M CMS-50M CMS-50M CMS-50M CMS-50M 8:30-10:30AM 5-6:30 PM 9:00-11:00 AM 8:30-10:30AM 5-6:30 PM 9:00-11:00 AM AM 9:00-11:00 AM NATIONAL PREP SUNDAY MONDAY TUESDAY WED THURSDAY FRIDAY SATURDAY CMS-50M MARQ CMS 50M CMS-50M MARQ CMS-50M CMS-50M CMS-50M AM AM 3-5 PM AM AM 3-5 PM AM 9-11 AM NATIONAL CMS- MARQUETTE CMS-50M MARQ CMS-50M CMS-50M CMS-50M CMS-50M 50M 8:45 A 1:30-4 dryland first 8:45 A 2-4 PM 8:45A 2-4 PM 8:45A 2-5P dryland first 8:45A 8:45A
RSCA SUMMER PRACTICE SCHEDULE Starting May 31, 2016 (Cont.) COLLEGE CMS-50M CMS-50M CMS-50M CMS-50M CMS-50M 6-7:30 AM 6-7:30 AM 6-7:30 AM 6-7:30 AM 6-7:30 AM HIGH SCHOOL PREP MARQUETTE MARQUETTE MARQUETTE 5:30-7:00 PM 5:30-7:00 PM 10:00-11:30 AM MASTERS MORNING CMS-50M CMS-50M CMS-50M CMS-50M CMS-50M CMS-50M 5-6:30 AM 5-6:30 AM 5-6:30 AM 5-6:30 AM 5-6:30 AM 5-6:30 AM MID-DAY MASTERS MARQUETTE MARQUETTE MARQUETTE 12:00-2:00 PM 12:00-2:00 PM 12:00-2:00 PM MASTERS EVENING CMS-50M CMS-50M 6:45-8:15 PM 6:45-8:15 PM