In Synch Summer Super Series Registration

Swimmer's Name*

First NameLast Name

Which camps would you like to register for?*

Rule The Pool - 26th August 9am-3pmSpin, Swirl, Twist & Twirl - 27th August 10am-4pmFigure Grade In A Day - 28th August 10am-4pmRoutine Grade In A Day - 29th August 10am-4pm

Date Of Birth*

Date

Gender*

MaleFemale

Address*

Street Address

Street Address Line 2

CityCounty

Postal Code

Parent/Guardian Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Emergency Contact Name*

First NameLast Name

Relationship*

Phone Number*

Does the athlete have any allergies, chronic illness, or medical conditions? This includes physical health, mental health and behavioural concerns. If yes, please describe.*

Is the athlete prescribed an inhaler? If yes, please explain any instructions.*

Does the athlete take any regular medication? If yes, please describe.*

Medical Release and Authorisation

As Parent and/or Guardian of the named athlete, I hereby authorise the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunisations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorisation is granted only after a reasonable effort has been made to reach me.

Permission is also granted to In Synch Training Camp and its affiliates including Directors, Coaches, Supervisors and Team Managers to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorised on the dates and/or duration of the registered camp.

This release is authorised and executed of my own free will, with the sole purpose of authorising medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

I am the athlete's parent or guardian and I authorise In Synch Training Camp to use photographs and video of the swimmer taken at camp for use on promotional material, social media or official website. (Swimmer will not be named)*

YesNo

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.*