Registration Form

Name of person completing this form: Parent or Legal Guardian*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Relationship to athlete*

MotherFatherOther legal guardian

Name: Athlete*

First NameLast Name

Athletes Date of Birth:*

Date

Athletes current age:

What is your athletes AAU registration number? If your athlete has a current AAU number, add it here. All athletes are required to register with the AAU, annually, to participate, NO EXCEPTIONS! If you dove with us in the fall, you do not need to provide your number, it is on file.

All athletes are required to register with AAU. Membership is $14. Enter club code: www.https://play.aausports.org/joinaau/multimembershipapplication.asp

My child is able to swim 25 yards of freestyle, unsupported? (Child must be able to swim 25 yards to be eligible to participate)*

YesNo

What session are you enrolling for?*

Does your child have any allergies, medical conditions or special needs that we need to be aware of to provide the best instruction? If so, please briefly explain (input "N/A" if not applicable): *

Additional parent or legal guardian information (please provide first and last name and phone number):

Emergency Contact Name and Phone Number:*

What school does your athlete attend?

IMPORTANT PLEASE READ ENTIRELY:

THERE IS A $25 ANNUAL REGISTRATION FEE FOR ALL ATHLETES. THIS REGISTRATION FEE COVERS INSURANCE LIABILITY AND PROCESSING FEES, AND IS REQUIRED BY THE AAU TO PARTICIPATE IN ANY AAU SPORT.

Memberships are valid from September 1 to August 31 and must be renewed annually. All registrations expire on 8/31 and must be renewed to continue diving for the next annual AAU season. Please contact us if you have any questions regarding AAU registration.

Tuition fees are due in full, at the time of enrollment, for the session. If a holiday falls within the session that we will be closed for, we have factored the cost per class fee out of the overall cost of the session. If you choose to pay by check, you may be assessed a $30 handling fee for a returned check. Replacement transactions must be in the form of cash, cashier's check, credit or debit, or money order. We reserve the right to drop students from classes for nonpayment.

THERE ARE NO REFUNDS. We rent facilities based on our enrollment.

Potomac Dive Club occasionally closes for observed holidays. These dates are factored out of the overall cost of the session prior to opening registration. On occasions, we may face closures due to challenges with the faclity or maintenance days. Account credits, refunds or makeups are not given for practices not held on observed holidays that were accounted for in advance or planned closures. If Potomac Dive Club must close unexpectedly, such as for inclement weather or an accident in the pool, we will provide a makeup class. In the event we cannot provide a makeup due to enrollment, we will work with you to provide other options. Due to limited space and safety reasons, we cannot guarantee makeup classes for missed classes that were not planned or brought about by Potomac Dive Club.

I understand that photographs/videos taken by Potomac Dive Club may be used by Potomac Dive Club. No payment, royalty or compensation shall become payable to me for reason of such use. If I do NOT agree to photos being taken or used, I will inform Potomac Dive Club in writing, and photos of my children will not be taken or used by Potomac Dive Club.

Diving is an individual sport that develops both physical and mental confidence and as a diver achieves more difficult skills, they develop stronger self-esteem. Although diving carries a low risk of catastrophic injury compared to other competitive sports, the risk is always present. No matter how careful the diver and coach are, no matter what height is used or what landing surface (including water), the risk cannot be eliminated. Safety will always be our top priority, and due to the nature of the risks and fears involved in diving, it is the coach, not the diver, who ultimately has the authority to make the final decision regarding performer readiness for diving skills.

Should a medical emergency arise during your child's participation in the Potomac Dive Club program, I understand that reasonable effort will be made to contact me. If I cannot be reached, or if it is believed that your child's life or health may be adversely affected by the delay that an attempt to contact me would cause, I consent to the administration of medical treatment and/or surgical procedures deemed necessary by the medical doctor and/or medical facility, and consent to the immediate administration of life sustaining measures deemed necessary under the circumstances.

Except for conditions that I have disclosed to Potomac Dive Club, to the best of my knowledge there are no physical or other conditions which will interfere with my child's participation. Safety rules are enforced. While our first priority is your child's safety, we must inform you that diving is not risk free. As a participant or as a parent or legal guardian of a participant in a Potomac Dive Club program, I am fully aware that diving can be strenuous, hazardous, and difficult. I acknowledge and freely accept the risks and hazards, including collisions, falls and risk of drowning, associated with the participation in diving. I agree to hold Potomac Dive Club LLC and its officers and agents free and harmless for any injuries or damages arising by reason of participation in this program.

Signature

Sessions: Please select all sessions that you are registering for. Package discounts or special discounts will be applied when your registration is processed. A $25 annual registration fee will be added for all new athletes or any athlete registering for a session that begins after 8/31 of their current registration year, upon registration. *

Dryland at Apollo Gymnastics (Woodbridge, VA) - ALL SKILL LEVELS - Friday -12 weeks Session: January 12 - May 17 from 4:15 - 5:15pm (see calendar on website for NO dive dates)