2020 Parkwood Piranhas Swim Team Registration

Parkwood Piranhas

2023 Swim Team Registration
Is this your family's first year with the Parkwood Swim Team?*

NoYes
Family Name*
Primary surname associated with swimmer(s) registration
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Adult Contact Info: Parent or Guardian
Adult 1*

First NameLast Name
Cell Number*
Primary E-mail*
Adult 2

First NameLast Name
Secondary E-mail
Secondary Phone Number
Emergency Contact*

First NameLast Name
Emergency Phone Number*
Family Doctor
Doctor Phone Number

Area CodePhone Number
Family Dentist
Dentist Phone Number

Area CodePhone Number
Preferred Emergency Room

DukeUNC
Age 15+ Swimmer's E-mail
If you want your 15+ teen(s) to receive swim team emails and approve of them being added to the google group, please enter their email address(es) here. Please provide name and email, separating multiple entries with commas.

Swimmers

* Note: Swimmers ages 5 to 18 yrs as of June 1, 2023 are eligible to register.
Swimmer 1*

First NameLast Name
Gender 1*
DOB Swimmer 1*

MonthDayYear
Date
Shirt Size 1*
Included for Swim Team Participants
How many years (including 2020 and this year, 2023) has the swimmer been swimming with DSSL? If more than 10yrs, indicate the number using the second drop-down menu.*
Important Medical/Behavioral information about your swimmer. (allergies, asthma, etc.)
Would you like to add another swimmer?

YesNo
Swimmer 2

First NameLast Name
Gender 2
DOB Swimmer 2

MonthDayYear
Date
Shirt Size 2
Included for Swim Team Participants
How many years (including 2020 and this year, 2023) has the swimmer been swimming with DSSL? If more than 10yrs, indicate the number using the second drop-down menu.
Important Medical/Behavioral information about your swimmer. (allergies, asthma, etc.)
Would you like to add another swimmer?

YesNo
Swimmer 3

First NameLast Name
Gender 3
DOB Swimmer 3

MonthDayYear
Date
Shirt Size 3
Included for Swim Team Participants
How many years (including 2020 and this year, 2023) has the swimmer been swimming with DSSL? If more than 10yrs, indicate the number using the second drop-down menu.
Important Medical/Behavioral information about your swimmer. (allergies, asthma, etc.)
Would you like to add another swimmer?

YesNo
Swimmer 4

First NameLast Name
Gender 4
DOB Swimmer 4

MonthDayYear
Date
Shirt Size 4
Included for Swim Team Participants
How many years (including 2020 and this year, 2023) has the swimmer been swimming with DSSL? If more than 10yrs, indicate the number using the second drop-down menu.
Important Medical/Behavioral information about your swimmer. (allergies, asthma, etc.)
Would you like to add another swimmer?

YesNo
Swimmer 5

First NameLast Name
Gender 5
DOB Swimmer 5

MonthDayYear
Date
Shirt Size 5
Included for Swim Team Participants
How many years (including 2020 and this year, 2023) has the swimmer been swimming with DSSL? If more than 10yrs, indicate the number using the second drop-down menu.
Important Medical/Behavioral information about your swimmer. (allergies, asthma, etc.)

Parkwood Swim Team: Swimmer Code of Conduct
It is the philosophy of the Parkwood Piranhas to allow maximum participation in swimming competition in an environment that encourages and teaches swimming skills in an atmosphere of fun, positive sportsmanship and with team spirit for swimmers of all levels. As such, we expect that all swimmers abide by our code of conduct and any swimmer who engages in conduct that is inconsistent with the team’s mission/philosophy is subject to dismissal from the team.

1. Swimmers may not engage in inappropriate behavior. This behavior includes: any form of harassment toward a coach, parent or teammate, use of rude language, gestures or remarks, unsportsmanlike conduct, or participating in activities which result in harm or violence to any person. This also includes any kind of sexual harassment towards other swimmers or coaches, including (but not limited to) unwanted touching, remarks, or other unwelcome attention.

2. Swimmers may not engage in any kind of digital harassing behavior toward other swimmers or coaches, e.g. texts, emails & social media. Digital harassment can include, but is not limited to, hostile language, unsolicited photographs, bullying, and sexual harassment.

Note: No photography or videoing is allowed in changing areas, restrooms, or from behind the blocks at any swim meets or events.

3. Swimmers will show respect for all DSSL facilities and other property used during practices, competitions and team activities.

4. If not otherwise specified in the league bylaws, DSSL defers to USA Swimming code of Conduct.

5. Please use changing rooms at facilities - no deck changing of attire is allowed.

If you notice a violation of the code of conduct please talk about this with your coach or parent representative. Violations of this code of conduct will be managed at the discretion of the head coach(es) in consultation with the Parent Organizing Committee (or similar). Disciplinary action may involve parent meetings, suspension, or removal of the swimmer from the team. The Parkwood Board reserves the right to remove any swimmer from the team who violates the Code of Conduct.

Swimmers, you are representing your team and your neighborhood. We have worked long and hard to present ourselves as a positive influence within the community. Each parent/guardian is responsible for securing acknowledgment of this code of conduct for their children.

By filling in names below, guardian(s) and swimmer(s) acknowledge receipt and
understanding of the Parkwood Piranhas Swim Team code of conduct.
Swimmer#1* Swimmer#2 Swimmer#3 Swimmer#4 Swimmer#5

Waiver/Release of Liability for Swimmer(s)

This is a release of liability and waiver of certain legal rights. This section is for informational purposes.
I, the undersigned participant and parent, request voluntary participation for a minor to participate in the events, which are hereinafter referred to as “activities”, sponsored by Parkwood Swim Club and Parkwood Piranhas Swim Team. I consent to my minor’s participation in the activities and acknowledge that the minor and I fully understand my minor’s participation may involve risk of serious injury or death, including losses which may result not only from my minor’s own actions, inactions or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas where the event or activity is being conducted, and/or the rules of play of this type of event or activity. I understand that if I have any risk concerns, I should discuss the risks associated with my participation with the activity coordinators and event staff before I sign this document and before any activities begin.

For and in consideration of entrance onto the premises, I agree to release Parkwood Swim Club and Parkwood Piranhas Swim Team and its owners, officers, operators, agents, employees, parent representatives, and volunteers, from, and waive any and all claims and liability arising out of the services they provide and/or use of their facility, including but not limited to personal injuries or damages arising from their ordinary negligence. This release and waiver applies to myself and any minor child I bring onto the premises.

Release – Parents’/Guardians’ and Minor’s Rights: In consideration of allowing Minor Participant to participate in the activities, I hereby release and hold harmless Parkwood Swim Club and Parkwood Piranhas Swim Team, the coaches, members of its board of directors, officers, employees, volunteers, other participants, parent representatives, and agents (collectively, the “Released Parties”), of and from, and do discharge and waive, any and all claims, demands, losses, damages, and liabilities that Minor Participant may have or sustain with respect to any and all damage and/or injury, of any type, arising out of his or her participating in the activities. I also agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect. I also certify that my minor is in good health and has no physical condition that would prevent participation in this activity. Furthermore, I agree to use my minor’s personal medical insurance as a primary medical coverage payment if accident or injury occurs. I consent to emergency medical treatment in the event such care is required.

Indemnification by Parent/Guardian:

The undersigned parent/guardian further agrees to indemnify, save and hold harmless the Released Parties from any and all claims, demands, losses, damages and liabilities for indemnities, contribution or otherwise with respect to any damage and/or injury, of any type, arising from Minor Participant’s participation in the activities. The undersigned also agrees that this Release and Waiver of Liability, Assumption of Risk and indemnity Agreement extends to all acts of negligence by the Release and is intended to be as broad and inclusive as is permitted by the laws of the State in which the Event(s) is/are conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

THE PARENT REPS WILL MAINTAIN A SIGNATURE PAGE FOR ALL PARENTS/GUARDIANS TO INDICATE AGREEMENT WITH THE CONDITIONS SET FORTH IN THIS WAIVER/RELEASE. PLEASE READ CAREFULLY. IF YOU AGREE TO THESE CONDITIONS, PLEASE SEE SIGN THE SIGNATURE BOX BELOW.

YOUR CHILD MAY NOT PARTICIPATE ON THE SWIM TEAM WITHOUT YOUR AGREEMENT TO THESE CONDITIONS.
Signature*

Clear

2023 is Back to Basics

We're thankful for a POOL, for practices, AWESOME Coaches and each other!

The classic Piranha is featured on this year's shirt:

Swim Team Fees

Registration fee includes a Piranha t-shirt and latex swim cap for each swim team member. Fees are $135 per swimmer for Parkwood Swim Club Members and $235 per swimmer for non-members. Registration deadline to guarantee a shirt is May 8th. Registration closes at the end of the first week of practices, May 19.
For Membership price - Join the Parkwood Swim Club: parkwoodswimclub.com (parkwoodswimclub.wildapricot.org)

Size	Quantity	Price
S		$15.00
M		$15.00
L		$15.00
XL		$15.00
2XL		$18.00
3XL		$18.00
4XL		$18.00

Size	Quantity	Price
S		$12.00
M		$12.00
L		$12.00
XL		$12.00
XXL		$15.00
XXXL		$15.00

Size	Quantity	Price
S		$20.00
M		$20.00
L		$20.00
XL		$20.00
XXL		$23.00
XXXL		$23.00

Now create your own Jotform - It's free!Create your own Jotform

Size	Quantity
Youth - S
Youth - M
Youth - L
Youth - XL

Parkwood Piranhas

Adult Contact Info: Parent or Guardian

Swimmers

Swim Team Volunteer Information

Parkwood Swim Team: Swimmer Code of Conduct

Waiver/Release of Liability for Swimmer(s)

Swim Team Fees

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