2020 Fall Registration Tuesday, September 8th - Friday, December 18th Swimmer's Information First Last Age Gender Shirt SizePlease specify Youth or Adult sizingBirth DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119202nd Swimmer's Information First Last Age Gender Shirt SizePlease specify Youth or Adult sizingBirth DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119203rd Swimmer's Information First Last Age Gender Shirt SizePlease specify Youth or Adult sizingBirth DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Costs (Select one):*Multiple swimmer discounts apply to household family members only.1 Swimmer $2152 Swimmers $3953 Swimmers $550High School Swimmer 1/2 Season $100Parent/ Guardian InformationParent/ Guardian #1* First Last Relationship Home PhoneWork PhoneCell PhoneEmail* Mailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/ Guardian #2 First Last Relationship Home PhoneWork PhoneCell PhoneEmail Emergency InformationPhysician's NamePhysician's PhoneMedical Insurance Co.Policy NumberMedical conditions we should be informed about: In Case of Emergency Contact (if parent/guardian is not available): First Last Phone In Case of Emergency Contact (if parent/guardian is not available): First Last Phone Photo ReleaseOnline Signature The St. Johns Sea Lions have my permission to use my child’s photograph publicly to promote the swim team. I understand that the images may be used in Sea Lions print publications, website, and/or social media. Consent To Participate and Medical ReleaseI hereby give consent for said minor to participate in the activities of the St. Johns Sea Lions (SJSL). By participating in this program, I will not hold any of the sponsors, supervisors, coaches, officials or volunteers of the SJSL or any local community responsible for any injury that said minor may sustain while participating in the above activities.I hereby authorize any duly authorized doctor, emergency medical technician, hospital or other medical facility to treat said minor for the purpose of attempting to treat or relieve any injuries received by said minor while he/she was a participant or observer at an event sanctioned or approved by U.S.A. Swimming and/ or SJSL. I authorize any licensed physician to perform any procedure which he/she deems advisable in attempting to treat or relieve any injuries or any related unhealthy conditions of said minor that he/she may encounter during any necessary operation.I consent to the administration of anesthesia as deemed advisable by any licensed physician.I realize and appreciate that there is a possibility of complications and unforeseen consequences in any medical treatment and I assume any such risk on behalf of myself and said minor. I acknowledge that no warranty is being made as to the results of any treatment.RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENTIn consideration of participating in the sport of swimming, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence St. Johns Sea Lions and it's owners, directors, officers, employees, agents, volunteers, participants, and all other persons or entities acting for them(hereinafter collectively referred to as "Releasees"), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows: 1. I acknowledge that the sport of swimming involves known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death and property damage. Risks include, but are not limited to, death as a result of drowning or brain damage caused by near drowning; broken bones, torn ligaments or strains as a result of fall on the deck or from a diving board; medical conditions resulting from physical activity: and damaged clothing and or property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity.2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation.3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury and/ or damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition.5. In the event that I file a lawsuit, I agree to do so solely in the state where Releasees' facility is located, and I further agree that the substantive law of that state shall apply.6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portion shall remain in full force and effect.7. I hereby agree to follow all safety and behavior policies set forth by the SJSL. Failure to do so can result in consequences up to and including termination from the SJSL Team. For full details of these policies please refer to the handbook posted online at sjsealions.comBy signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim of negligence.I have had sufficient time to read this entire document and , should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. Online Signature I have read and understand this document and am bound and agree to its terms. Print NameDate Signed Date Format: MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged.
