2025 Tri-State Cup All-Star Athlete Application

Application Deadline December 18, 2026

Athlete Information

Legal First Name

Middle Name

Last Name

Preferred First Name

Birth Date

Age (on 1/16/2027)

Gender

Shirt Size

Club

Athlete Cell

Athlete E-Mail

Street Address

City

State

Zip Code

Medical Conditions

Please list your top six individual events (SCY only), best times and dates achieved.

Parent/Guardian Information

Parent/Guardian 1 Name

Parent/Guardian 1 Cell

Parent/Guardian 1 E-Mail

Parent/Guardian 2 Name

Parent/Guardian 2 Cell

Parent/Guardian 2 E-Mail

Emergency Information

Emergency Contact Name

Emergency Contact Cell

Emergency Contact E-Mail

Comments/Questions

Swimmers selected for the team will be required to pay a team fee, of $250.00.

Liability Waiver & Medical Release

By registering my child(ren) with the Allegheny Mountain Swimming Tri-State Cup All-Star Team, I agree to participate (or allow my child(ren) and family members to participate) in the Tri-State All-Star Meet, and hereby release Allegheny Mountain Swimming, its directors, officers, agents, coaches, and employees from liability for any injury that might occur to myself (or to my child(ren) and family members) while participating in the Tri-State Cup All-Star Meet, including travel to and from training sessions, swim meets or other scheduled team activities. I agree to indemnify and hold harmless the above mentioned organizations and/or individuals, their agents and/or employees, against any and all liability for personal injury, including injuries resulting in death to me, my child(ren) and/or other family members, or damage to my property, the property to my child(ren) and/or other family members, or both, while I (or my child(ren) or family members) participating in the Allegheny Mountain Swimming program.

I certify that I am the parent or legal guardian for my child(ren). I hereby give my permission for any supervisor, coach or other team administrator associated with the Allegheny Mountain Swimming to seek and give appropriate medical attention for our child(ren) in the event of accident, injury, illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment. I hereby waive, release and forever discharge Allegheny Mountain Swimming and associated supervisor, coach or other team administrator from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Allegheny Mountain Swimming activities, whether or not damages or loss is due to negligence. I hereby acknowledge that my children is (are) physically fit and capable of participation in all Swim Team activities.

2027 Tri-State Cup All-Star Athlete Application