2016 Learn To RowRegistration
Athlete’s FullName
HomeAddress
HomePhoneAgeDate ofBirth
Gradein2016-‐17HeightWeight
ParentName
CellNumber
E-‐mailAddress
HomeAddress
(if different fromathlete)
ParentName
CellNumber
E-‐mailAddress
HomeAddress
(if different fromathlete)
ThefeefortheLTRProgramis$375.00 per sessionwhichincludes2landbasedclassesand8on-watertrainings. Pleaseindicatewhichrowingsessionyouwouldliketoattend.Pleaselist1st and2nd choices:
Session1: June13, 14 forlandclasses;June26-‐30July5-7on-‐watertraining
Session2:June13,15 for landclasses; August1-4August8-11on-‐watertraining
Session3:June13, 16for landclasses; August15-18August22-25on-‐watertraining
Swim Test FormAttached
Swim tests must be signed off by a certifiedlifeguard.
Emergency MedicalRelease
I give permission for full participation in Westfield Competitive Rowing, Inc. (hereafter: WCRI) activities, subjecttolimitations noted herein. In case of an emergency, I understand that every effort will be made to contact me. Intheevent I cannot be reached, I hereby give my permission to the licensed health-care practitioner elected by the Head Coach or Coach on Duty (CoD) to secure proper treatment, including hospitalization, anesthesia, surgery,orinjections of medication for mychild.
Parent/GuardianInitial:
Informed Consent and Hold HarmlessAgreement
Iamanamateurathlete.Inparticipation,Iwill observetherulesandregulationstheUSRowingAssociation(hereafter, USRA) andWCRI. Inconsiderationof myathlete’sapplicationandacceptanceasamemberof theprogram and their participation therein, I do hereby for myself, my heirs or assignees release and dischargeWCRIanditsdirectors,officers,members,andagentsfromanyresponsibilityandallmannerofactions,suits,debts,damages,orclaimsinlaworinequitythatIormylegal representativesmayhavebereasonofmyathlete’spersonalinjury,lossofordamagetoequipmentoranypersonalpropertybelongingtohimwhichmayaccrueduring and by reason of his participation as a member of said program provided by Westfield CompetitiveRowing,Inc.
AthleteName:
AthleteSignature:Date:
ParentName:
ParentSignature:Date:
Pleasecompletethisformandreturnitwithacheckfor$375.00(madeouttoWCRI)Send to Westfield Crew c/o Sharon Hindes 19 Azalea Trail, Westfield, NJ07090.
Refunds may be requested until June 1,2016
RegistrationformandpaymentmustbereceivedbeforeyourathletemayattendLTRlandtrainingorrowingsessions. Westfield Crew will confirm receipt of your registration form and payment, and verify yourLTRsession.