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Personal Information Sessions Medical Release and Liability Waiver Payment
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23/24 Winter/Spring Swim (Jan - May)

Use this form to register for the Winter/Spring SWIM session that runs from January 6, 2024 through May 11, 2024

Parent/Guardian Information
  • At least one parent/guardian registration is required. New accounts will be sent an email confirmation message with instructions to set up 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.
  • Previously registered parents/guardians cannot be edited during registration. Please contact your team's admin to request edits.
First Name * Last Name * Email Address *
Required for login
 Primary Phone

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Athlete Information
  • At least one athlete registration is required.
  • Previously registered athletes cannot be edited during registration. Please contact your team's admin to request edits.
First Name * Preferred Name Middle Initial Last Name * Competition Category * Birth Date *
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Home Address

Membership Number

What is your pool membership number? *

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 engaging in an activity that involves risk of serious injury.  I agree that my child(ren) swim and/or dive at their own risk and therefore agree to hold harmless, 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.

*
Enter your initials to indicate acceptance: *
Health Screening

To protect those involved with the Rolling Hills Swim & Dive team, I commit to completing a daily health screening of my child/ren and to not send my child/ren to team events and/or activities when they are sick or feeling unwell with the symptoms consistent with COVID-19 or other contagious illnesses. This commitment will apply to all Rolling Hills Swim & Dive athletes in my home.

I agree to keep my child at home if he/she has any of the following symptoms:

  • Feverish and/or having chills (if documented temperature/fever of 100.4F or greater)
  • Has used any fever reducing medicine within the last 24 hours
  • New cough not due to another health condition
  • Unusual fatigue (more tired than usual)
  • Difficulty breathing
  • Nasal congestion or runny nose not due to another health reason
  • Headache
  • New sore throat not due to another health condition
  • New muscle pain not due to another health condition or that may have been caused by a specific activity such as physical exercise
  • New loss of taste or smell, new onset of poor appetite or poor feeding
  • Abdominal pain, diarrhea, nausea, vomiting
  • Have had a positive test for the virus that causes COVID-19 within the past 5 days 
*
Enter your initials to indicate acceptance: *
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.

*
Enter your initials to indicate acceptance: *

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