Athlete Registration Form
Athlete Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Athlete's age in years
Please Select
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Please select number of days for participation. 1-4
Please Select
FISH (1 day a week)
NOVICE (2 days a week)
12UI/intermediate (3 days a week)
AG (4 days a week)
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian
Does the athlete have any physical limitations or medical conditions?
Yes
No
Please explain and list any medications used.
Does the athlete have any allergies?
Yes
No
Please explain and list any medications used
During the warmer months, bees do like to be around the pool, if your child has an allergy to bee stings please ensure they have their EPI-PEN or equivalent medication in their swim bag.
Physician Name
First Name
Last Name
Physician Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Insurance
Insurance Company
Insurance Policy #
Insurance Group #
Dentist Name
First Name
Last Name
Dentist Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Insurance
Insurance Company
Insurance Policy #
Insurance Group #
Emergency Contacts
My child T-shirt size is:
Youth Size Small
Youth Size Medium
Youth Size Large
Adult Small
Adult Medium
Adult Large
Adult Xtra-Large
I authorize CSA Synchro coaches or appointed chaperones to seek emergency and/or medical treatment for my child named above.
As a member of the Cygnet family (athlete and family members), I understand that the Cygnets of San Antonio, including its representatives, and employees may use my name and/or my child's, voice, picture or other likeness in photographs and videos taken during club activities, including but not limited to practices and competitions. I understand that these materials may be used for promotional purposes on the club's marketing outlets and social media platforms. I recognize that the Cygnets of San Antonio may utilize this content globally and indefinitely without the need for additional consent, notification, or compensation, unless otherwise legally restricted.
I authorize CSA Synchro coaches or appointed chaperones to seek emergency and/or medical treatment for my child named above.
Please select one of the two options for fundraising
My athlete and I agree to participate in fundraising efforts this season to fulfill our personal fundraising obligation (PFO).
My athlete and I prefer not to participate in fundraising efforts and will pay outright for our personal fundraising obligation (PFO).
Date
-
Month
-
Day
Year
Date
Signature of Parent/guardian
Submit
Submit
Should be Empty: