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WINTER SWIM: Winter/Spring Session (Jan - May) Registration form

Use this form to register for the winter swim session that runs from 1/12 through 5/25

Parent/Guardian Information

At least one parent/guardian registration is required.
New accounts will be sent an email confirmation message with instructions to setup a password.

At least one parent/guardian email address must be provided.
Check the boxes to indicate which parent/guardians should receive team-wide emails.

First Name * Last Name * Email Address *
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Primary Phone

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Athlete Information

Enter the information for each athlete being registered below. At least one Athlete registration is required.

First Name * Preferred Name Middle Initial Last Name * Gender * Birth Date *
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Home Address

Membership Number

What is your pool membership number? *

NVSL Participation Waiver

As Parent/Guardian of the above-named minor(s), I grant permission for the swimmer(s)/diver(s) to participate in all activities of the Rolling Hills Swim & Dive Team, a Northern Virginia Swimming League (NVSL) member team.  I represent and warrant that my minor child/children participating on the Rolling Hills Swim & Dive Team are in good health and have no physical condition, ailment or disability which renders them unable to participate in vigorous physical activity.  For and in consideration of benefits derived from participation in the Rolling Hills Swim & Dive Team program, I understand that the risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equpment, and personal discipline may reduce this risk, the risk of serious injury does exist.  I assume all risks and hazards arising out of, or related to, such participation, including, but not limited to, transportation to and from such activitites, and do hereby indemnify, release and hold harmless the Rolling Hills Swim & Dive Team, its coaches, team representatives, volunteers, property manager, employees and agents, as ewll as the Northern Virginia Swimming League, from all claims of any kind whatsoever which may arise or hereafter accrue in connection with my child's/children's participation in activities of the Rollign Hills Swim & Dive Team.  I further grant permission for first aid to be given to my child/children in an emergency, and will be solely responsible for any medical costs which may arise.  I AGREE THAT THEY WILL ABIDE BY THE NORTHERN VIRGINIA SWIMMING LEAGUE CODE OF CONDUCT.

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Rolling Hills Photo Release

I authorize Rolling Hills Swim Club and their official photographer/s the right to take photographs of me and my family in connection with Rolling Hills Swim & Dive Team Events.  I authorize Rolling Hills Swim club, its assigns and transferees to copyright, use and publish the same in print and/or electronically.

I agree that Rolling Hills Swim Club may use such photographs of me without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

I have read and understand the above.

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Rolling Hills Liability Waiver

I hereby authorize and give my swimmer(s) and/or diver(s) permission to fully participate in the Rolling Hills Swim and Dive Team.  I understand that my child(ren) is/are engagine in an activity that involves risk of sericous injury.  I agree that my child(ren) swim and/or dive at their own risk and therefore agree to hold hamless, indemnify, and release the Rolling Hills Swim Club, its Board of Directors, Swim and Dive Team Representatives, and Swim & Dive Coaches from any and all liability for damage and/or injury incurred as a result of participation in the Swim and Dive program.

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