2017 PLATTSMOUTH PIRANHA SWIM TEAM REGISTRATION FORM (Up to 15 years old: $65.00 per swimmer, $5 discount for each additional swimmer; Ages 15-18: $25) Name on T-Shirt / Hoodie is in ALL BLOCK LETTERS Either First or Last Name Items Sizes Cost T-shirt Circle / Type YXS YS YM YL YXL AS AM AL AXL AXXL(+$2) Cost: $17 Hoodie Circle / Type YM YL YXL AS AM AL AXL AXXL(+$4) Cost: $27 Swimsuit Size: F($30) M($25) Tank Top Circle: Womens: XS S M L XL XXL XXXL XXXXL Cost: $15 Junior Fit Golf Shirt Dri Fit Mens: XS S M L XL (XXL +2) Cost: $30 Womens: XS S M L XL (XXL XXXL +2) Visor One Size Fits All Cost: $17 Baseball Cap One Size Fits All Cost: $16 Zipper Hoodie Adult Size Only: AS AM AL AXL AXXL (+4) Cost: $27 Names on T-Shirt / Hoodie Family Name: Total Order: Cost T-Shirts x $17 ea Hoodie x $27 ea Swim Suits x $25 / $30 Circle HERE if we need to Order Suit Tank Top x $15 ea Golf Shirt (Mens) x $30 ea Golf Shirt (Womens) x $30 ea Visor x $17 ea Baseball Cap x $16 ea Zipper Hoodie x $27 ea If you want team logo and/or name on back +$4 ea)
Swimmer Last Name: SWIMMER(S) INFORMATION 1 st Swimmer Name: M F (Circle ) Allergies: 2 nd Swimmer Name: M F (Circle) Allergies: 3 rd Swimmer Name: M F (Circle) Allergies: 4 th Swimmer Name: M F (Circle) Allerigies: Last Name: FAMILY INFORMATION Parent s Names: Email Address: Phone: Address: City: State: ZIP: Mother s Cell: Father s Cell: Other: Name (other than parent listed above): Phone: EMERGENCY CONTACT Relationship: Medical Information Hospital/Clinic Preference: Physician Name: Physician Number: IMPORTANT: The Plattsmouth Piranha Swim Team does not accept responsibility for your child. Therefore, please supervise your child(ren) appropriately. Medical information is collected for safety reasons only.
Consent I give my permission for photos of my child to be displayed on the team website. I have read and explained to my child the Code of Conduct. I have received information regarding concussions and understand my responsibilities if my child is suspected of having a concussion. My child will not be able to participate again until cleared in writing by a licensed healthcare provider and in writing by a parent/guardian. Limitation of Liability I understand participation in swimming entails certain dangers. Each family assumes the risk of personal and property injury to the swimmer, his/her family and his/her guests sustained during Swim Team, and assumes the risk voluntarily. By my signature below I, for myself, my heirs and assigns, waive any and all claims for damages on account of personal injury or property against Plattsmouth Swim Team and its representative sponsors arising out of, or related to my participation in any and all activities for Plattsmouth Swim Team. I agree to be solely responsible for any medical, health or personal injury costs relating to participation in Plattsmouth Swim Team. Parent Signature: Date:
Swimmer Last Name: REGISTRATION FEE: PAYMENT (Make Checks Payable to: Plattsmouth Swim Team) 1 Swimmer (<15) $65.00 2 Swimmers $65.00 + $60.00 = $125.00 3 Swimmers $65.00 + $60.00 + $55.00 = $180.00 4 Swimmers $65.00 + $60.00 + $55.00 + $50.00 = $230.00 Swimmer (15-18) $25 each $ Registration $ Shirts $17 $ Hoodies $27 $ Tank $15 $ Dri Fit Golf Shirt $32 (2XL $34) $ Baseball Hat $16 $ Visor $ 17 $ Zipper Hoodie $27 (2XL 3XL +4) $ Swim Suits (F - $30 / M - $25) $ Goggles Caps etc. $ Total Cash/Check # MANDATORY 1 $ 35 Volunteer DEPOSIT Check # $35 will be returned once family volunteer commitment (2 meets and 1 Invitational) has been completed.
Plattsmouth Piranha Code of Conduct Failure to abide by the following code of conduct will result in a swimmer and/or parent/guardian being asked to leave practice, the meet and/or the team. Swimmers must follow these rules to stay in good standing: 1. Plattsmouth swimmers are expected to remember that at practice, during swim meets and in public they are representing Plattsmouth Swim Team. They should represent Plattsmouth with excellence, team spirit, good sportsmanship, and politeness. 2. Plattsmouth swimmers are expected at all times to follow the directions of any meet official, coach or parent working a meet. Disrespect or failure to obey instructions will not be tolerated from any athlete. 3. Plattsmouth swimmers are expected to use appropriate language. Use of profane or abusive language or obscene gestures will not be tolerated. 4. Plattsmouth swimmers are expected to respect each other. Fighting, intentional touching or striking another athlete will subject the swimmer to the most severe discipline. 5. Plattsmouth swimmers are expected to respect and care for the property of others and all facilities. Vandalism, intentional damage to property or theft of property will not be tolerated. 6. Swimmers must notify the coach in advance if they are planning to leave swim meets early. 7. Disruption of practice by an athlete will be grounds for removal. Parents/guardians are the most important role models for their children, and that sports help to develop a sense of teamwork, self-worth and sportsmanship. As such, parents agree to abide by the following: 1. Encourage good sportsmanship by demonstrating positive support for all players, coaches, fans and officials at games, practices and other sporting events. 2. Place the well being of my child before a personal desire to win. 3. Advocate a sports environment for my child that is free of inappropriate language and actions 4. Encourage my child to play by the rules and respect the rights of other players, coaches, fans and officials. Signature on Registration signifies receipt and understanding of the Plattsmouth Piranha Code of Conduct.