Splash Registration 2020

Splash Registration 2020
Address

6660 E Eastman Ave

US

DenverCO

80224
Name

SophiaInghilterra
Date of Birth

MonthDayYear
06/07/2008
Swimmer's Phone Number

720480-7600
Swimmer's Email
kim.inghilterra@gmail.com
Please check if registering more than one Swimmer

Add Additional Swimmer
2nd Swimmer's Name

First NameLast Name
Date of Birth

MonthDayYear
Date
2nd Swimmer's Phone Number

Area CodePhone Number
2nd Swimmer's Email
example@example.com
Parent's Name*

First NameLast Name
Please check if address is different than Swimmer's

Add New Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email *
example@example.com
Check to add 2nd Parent

Add Parent
2nd Parent's Name

First NameLast Name
Please check if address is different than Swimmer's

New Address
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com

USA Synchro Registration
All USA SYNCHRO FORMS HAVE BEEN RECEIVED. PLEASE CLICK NEXT AT THE BOTTOM OF THE PAGE TO COMPLETE THE REGISTRATION.

Please upload a completed the USA Synchro Registration form. A copy of the form was attached to the registration email or it can be downloaded from this page to your computer and complete the fields by typing in the information. Once the form is completed, it can be printed for a signature. Please upload the completed form using the button at the bottom of the page.

If your Swimmer(s) has a current USA Synchro Registration please provide that information by uploading it using the button below. This may apply to Swimmers transferring from another club or summer league.

Current Splash swimmers and those without a USA Synchro Registration must have this form completed for registration.
All USA SYNCHRO FORMS HAVE BEEN RECEIVED. PLEASE CLICK NEXT AT THE BOTTOM OF THE PAGE TO COMPLETE THE REGISTRATION.

Please upload a completed the USA Synchro Registration form. A copy of the form was attached to the registration email or it can be downloaded from this page to your computer and complete the fields by typing in the information. Once the form is completed, it can be printed for a signature. Please upload the completed form using the button at the bottom of the page.

If your Swimmer(s) has a current USA Synchro Registration please provide that information by uploading it using the button below. This may apply to Swimmers transferring from another club or summer league.

Current Splash swimmers and those without a USA Synchro Registration must have this form completed for registration.
Upload Completed USA Synchro Registration Form

Browse Files
Multiple files can be uploaded. Please complete one form for each swimmer Cancelof
Emergency Contact & Medical Information
Please provide contacts in the order that you would want us to call. Please make sure there are a minimum of 3 contacts.
Emergency Contact 1*

First NameLast Name
Phone Number*

Area CodePhone Number
Emergency Contact 2*

First NameLast Name
Phone Number*

Area CodePhone Number
Emergency Contact 3*

First NameLast Name
Phone Number*

Area CodePhone Number
Emergency Contact 4

First NameLast Name
Phone Number

Area CodePhone Number
Medical Information
Physician Name*
Physician Phone*

Area CodePhone Number
Insurance Company*
Policy Number*
Upload an Image of the Front & Back of Insurance Card*

Browse Files
Multiple files can be uploaded. Please include insurance cards for all swimmers Cancelof
Any Allergies or Health Concerns*
Prescription medications, if needed. The medication has to be in the original package with the correct dosage
Medication
Administration Times
Medical Authorization

I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the event that neither parent/guardian can be reached in the case of an emergency. Financial responsibility for such treatment will rest with the parent/guardian.
Medical Authorization

I authorize prescription medications to be administrated according to the original dose and time on the container.
Do we have your permission, as parent/legal guardian to provide over-the-counter products for relief of headache, muscle pain, stomach upset, upper respiratory congestion, etc. Label instructions will be used for proper dosages. Such products would be used in the interest of your swimmer’s comfort and wellbeing?
Medical Authorization

YesNo
Signature*

Clear
Use the computer's mouse to sign your name
Date*

MonthDayYear
Date

Consent to Photograph, Film or Videotape an Athlete for Non-Profit Use
I hereby consent to the taking of Photographs or videos of the athlete(s) {swimmersName} {2nd4} by the RockyMountain Splash Synchronized Swim Team and its agents.

The Team’s intent in using the photos is to promote and advertise the team through the team website, on lesson flyers, Girl Scout recruiting and to include photos for programs at national meets. Photos and videos may also be posted on the Rocky Mountain Splash Website. www.rmsplash.org

I also grant to Rocky Mountain Splash the right to edit, use and reuse the photographs or videos for educational and non-profit purposes including use in print, on the internet and all other forms of media.

I also hereby release the Rocky Mountain Splash Synchronized Swim Team and its agents, coaches, and Board of Directors, from all claims, demands, and liabilities whatsoever in connection with the above.
Date

MonthDayYear
Date
Signature*

Swimmer/Parent Contract
ALL TEAM MEMBERS ARE EXPECTED TO CONTACT THEIR COACH WHEN THEY CANNOT BE AT PRACTICE. PLEASE MAKE THIS CONTACT BEFORE 4PM.

DO NOT HAVE A TEAMMATE EXPLAIN YOUR ABSENCE!!

Due to our limited time and resources this year it is of the utmost importance that team members be at practices in order to utilize our time as productively as possible.

Once you receive the Splash Meet Schedule, PLEASE look at it carefully and note our synchro dates! Once the dates are finalized we are unable to change them! We may not have an alternate for your routine, so we expect you to be in attendance at all meets.

#1 – We will look at the SPLASH MEET & EVENT SCHEDULE and will mark our calendar with the important synchro dates.

#2 – Before practice begins, I agree to call, text or email my coach when I cannot be there. Your coach will reply to you letting you know they acknowledge your absence. If you do not receive a reply from your coach before practice begins, they have not received your first contact, so please try again. I also understand that it will be the decision of my coach that due to chronic absences I may be replaced in a routine, keeping the best interest of the team in mind.

#3 – Our family agrees to pay ALL FEES incurred due to membership registration, monthly dues, meet fees, suits, and misc. team fees, as well as travel by June 1, 2018. The Splash Season is from September 2019 – June 2020; for some swimmers, it may extend through July 2020 depending on meet attendance.

#4 – I understand I may not miss ANY practice the 2 weeks prior to a meet. This especially applies to the 2 weeks prior to the US Nationals, Junior Olympics, Zones or any other meet as designated by the coach, unless this has been previously approved by your coach (weddings, graduations, etc.)

#5 – It is expected that every Splash family will volunteer at meets, assist at special events, donate to concessions, and to help out when needed. It is also requested that families participate in the fundraising efforts and in the administration of at least one fundraiser.

#6 – I will continue to swim as long as my team qualifies, i.e. through Regional and/or National meets, etc.

#7 - Any member who resigns from the team must submit a written letter of resignation to the Board of Directors. Appropriate dues are payable through the month in which the letter of resignation is submitted and are due within 30 days of the date of the letter. Any outstanding credits are released to general team funds.
Signature: By signing I acknowledge that Parents and Swimmers are aware of these policies *
Date

MonthDayYear
Date

Bingo Policies
Please review the bingo policies.
Acknowledgment of Bingo Policy*

We have been provided with a copy of the RMS Bingo Policy and agree to its terms.Working bingo throughout the entire year (52 weeks) is mandatory. RMS works bingo during holiday seasons, spring break, & summer break.The bingo scheduling block depends on the amount of swimmers signed up per season. Currently, commitments equal the number of days your swimmer typically has practice per week.When completing the Bingo Sign Up sheet at least one (1) worker must be available for at least two (2) different Sundays.RMS compiles and releases a team roster. The team roster has contact information for every member. We will ensure that we have access to the team roster so we can contact members with regards to bingo issues. I have entered Janet Prezkurat (JP) cell phone number into my phone, 303.697.9021If we cannot work our scheduled session, we will make “contact” with the session manager. We will not assume that the manager received our email, text, or voice message. We will make sure we receive a reply from the manager. When the session manager deems it necessary, we will be required to find a qualified replacement worker(s) for our missed session.At least one (1) family member over age 21 must complete the CO Games Manager Training within 18 months of joining the team. http://www.sos.state.co.us/pubs/bingo_raffles/bingoHome.html is link to online training and testing.Cell phone use within the sight of bingo players is not acceptable. In the event of an emergency, please use your cell phone out of the view of bingo players.
RMS must submit the name of every potential bingo worker to the Colorado Secretary of State. Please clearly print the first and last name of all potential 2019-2020 bingo workers for your family. Please list your swimmer if s/he will be 14 or older by Dec. 2019. Please list possible raffle workers (mature 13-year-olds) and note their b-day. Also, please note if a worker is only “potential” and will not currently be working bingo. Once again, please list all potential 2019-20 bingo workers as the Colorado SOS does not appreciate constant revisions to our worker list.
Enter Bingo Workers Names. Include Birthdays for Swimmers*
please use a semicolon to separate names
Email to Receive Bingo Correspondence*
example@example.com
Email to Receive Bingo Correspondence
example@example.com
Winner's Bingo

13680 E Alameda Ave, Aurora, CO 80012

We work three sessions on Sundays. The first one is an arrival time of 1:30pm the second at 4:45pm. The second works two sets of bingo games.
I have been provided with a copy of the Rocky Mountain Splash Parents’ Corporation Bingo Policy and agree to its terms.*

Splash Handbook
We acknowledge receipt of the Rocky Mountain Splash Handbook and Bingo Policy and agree to its terms. We further verify that we have read and understand its contents, and agree to abide by the policies contained therein*

ATHLETIC WAIVER AND RELEASE OF LIABILITY (“AGREEMENT”)

(PLEASE READ CAREFULLY BEFORE PARTICIPATING IN ACTIVITY)
In consideration for the opportunity to participate on the synchronized swimming team ROCKY MOUNTAIN SPLASH ] (the “Activity”) {swimmersName}, {2nd4} ("Participant(s)") acknowledges and agrees as follows:

1.  Inherent Risks and Assumption of Risk. Participant acknowledges that she is voluntarily engaging in the Activity, and that the Activity could involve risk of injury, both serious and minor, including, without limitation, concussion, neck or spinal injuries, eye or face injuries, cuts, abrasions, contusions, or other physical bodily injuries, both foreseen or unforeseen, which might result from either Participant’s own actions or the actions or inactions of Splash. Participant knowingly and freely assumes all such risks, both known and unknown, even if arising from the negligence of Splash or others, and assumes full responsibility for her participation in the Activity.

2.         Release. Participant, for herself, and on behalf of her heirs, assigns, personal representatives and next of kin (“Releasors”), hereby releases, waives and forever discharges Splash and its officers, directors, coaches, swimmers, representatives, agents, contractors and their respective successors or assigns, (referred to individually and collectively as “Releasees”) from any and all liability for any and all losses or damages and all related claims, on account of any injury, disability, or loss or damage to person or property, or death which arise from or relate in any way to the Activity, whether caused by the negligence of any Releasee or otherwise.

4.         Participant’s Certification. Participant certifies that she is physically fit and that there are no health-related reasons or problems or illness which preclude her participation in the Activity.

5.         Limitation of Liability. If, for any reason, the above release is found to be unenforceable, Releasors agree that (i) any action brought under this Agreement shall be time barred unless brought within one (1) year of the incident or accident giving rise to said claim, and (ii) Releasors agrees that the amount of damages that Releasees shall be required to pay shall not exceed $200 for property damage and a maximum of $1,000 for all other damages, including but not limited to personal injury, death, or pain and suffering.

6.         Severability. The invalidity or unenforceability of any provision of this Agreement will in no way affect the validity or enforceability of any other provision.

7.         Attorneys’ Fees. If any action at law or in equity is necessary to enforce or interpret the terms of this Agreement, the prevailing party will be entitled to recover its reasonable attorneys’ fees, costs, and necessary disbursements in addition to any other relief to which the party may be entitled from the other party.

8.         Entire Agreement. This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes and merges all prior agreements or understandings, whether written or oral, with respect to the subject matter hereof. This Agreement shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I CERTIFY THAT I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS CONTENT, UNDERSTAND THAT I MAY HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING, AND SIGN IT OF MY OWN FREE WILL.
Participant's Signature*
Enter Name*
FOR PARTICIPANTS UNDER THE AGE OF 18 AT THE TIME OF REGISTRATION

This is to certify that I, as parent/guardian with legal responsibility for Participant, do consent and agree to her release as provided above of all Releasees, and for myself, my heirs, assigns, personal representatives and next of kin, I release and agree to indemnify and hold harmless Releasees from any and all liabilities incident to Participant’s involvement or participation in the Activity, even if arising from negligence of any Releasee, to the fullest extent permitted by law.
Parent or Guardian Signature
Enter Name
Date*

MonthDayYear
Back

Should be Empty:

Splash Registration 2020

USA Synchro Registration

Emergency Contact & Medical Information

Medical Information

Consent to Photograph, Film or Videotape an Athlete for Non-Profit Use

Swimmer/Parent Contract

Bingo Policies

Splash Handbook

ATHLETIC WAIVER AND RELEASE OF LIABILITY (“AGREEMENT”)