Summer Ducks

Summer Swim Team

Registration Form

Redding Swim Team

P.O. Box 992112

Redding, CA96099-2112

Phone: 530-246-2666

Email:

Web site:

Welcome to the

“Summer Ducks”

This swimming program will fit the needs of the ‘summer only’ swimmer. Regardless of

your competitive nature, ability, or age, we have a place for you. In this program, you will

work on stroke technique, starts, and turns, fitness and, most of all, FUN!!

TWO PROGRAMS

Our Youth Summer Ducks Swim Team Program will be held at the ReddingAquaticCenter or

ShastaCollege. The cost for Youth Program is only $ 112 for the entire summer. This includes registration with United States Swimming and dues for the entire summer.

Ages 5-18 years old.

Our High School Summer Ducks Program for kids in 8th Grade through High School will be held

at ShastaCollege. The cost of our High School Programis only $162 for the entire summer.

This includes:Registration with United States Swimming and dues for the entire summer.

Grades 8th – High School.

We will start practice sessions on June 8th and end the season on August 2nd. We

encourage all participants to compete in summer meets and our NVAL championships

at the end of the summer,July31 - August 2,at ShastaCollege.

So, bring your friends and get ready for a fun, safe and exciting swim season with the

REDDING SUMMER DUCKS!

Swim practices are offered Monday through Thursday, at two locations for your convenience.

Please indicate which Pool and Time you will be attending.

Please, Circle the pool and time you would like to participate:

Youth Program (5-18 years old) - ReddingAquaticCenter 10:00 -11:00am(Mon-Thurs) or

> Youth Program (5-18 years old) - ShastaCollege at 11:00 - 12:00 pm (Mon-Thurs) or

> Youth Program (5-18 years old) - ShastaCollege at 5:00 - 6:00 pm (Mon-Thurs) or

> High School Program (8th Grade & High School) – Shasta College at 8:00 -9:30 am (Mon –Thurs)

Many of our year round swimmers started swimming in a ‘summer only’ capacity but have gone on

to swimyear round because of the fun, success and friendships they made.

We have limited our number of swimmers this year to better serve all the swimmers in the program.

First come – first served. Children must be able to swim 15yards freestyle or backstroke to join.

  • If you have any questions, please call our office at 246-2666.

MEDICAL AUTHORIZATION FORM

REDDING SWIM TEAM and SUMMER DUCKS

Name of Participant

Last First MI

Address City State_____ Zip

Home phone Work phone Cell phone

E-Mail Address Date of Birth Sex _____

Parent/Guardian Name (if under 18)

Mother’s Name

Address Home Phone Work Phone

Father’s Name

Address Home Phone Work Phone

If an insurance company covers your child, please complete the following:

Name of Carrier: Address:

Phone Policy Number

Family Physician Phone

Emergency Contact Phone

All information will remain confidential.

Does this athlete have any allergies? Bee stings, medications, etc.? Is this athlete taking any medication? Yes/No (if yes, please list medication)

Do you feel this athlete is physically able to stand the rigors of swimming?

The undersigned does hereby waive, release and indemnify REDDING SWIM TEAM, its agents

and employees from any and all claims or demand for injury or damages arriving out of or incurred

while participating in any activity sponsored by, or connected with, REDDING SWIM TEAM and

U.S.A. SWIMMING.

I hereby authorize any adult member of the REDDING SWIM TEAM to secure medical help at my expense when necessary. This form is valid May 1, 2009 to September 30, 2009.

Date:

Signature of Parent or Guardian

Mail this form and the other side to: Redding Swim Team

P.O. Box 992112

Redding, Ca. 96099-2112

United States Swimming- SIERRA NEVADA Swimming2009 ATHLETE REGISTRATION APPLICATION

PLEASE PRINT * COMPLETE ALL INFORMATION

//

LAST NAMELEGAL FIRST NAMEMIDDLE NAMEDATE OF BIRTHSEX (M/F)

PREFERRED NAMEMAILING ADDRE CITYZIP

HOME NUMBERCELL PHONE

RADRedding Swim Team CITIZEN?DUAL CITIZEN?

CLUB CODENAME OF CLUB YOU REPRESENT YES NO YES NO

   

OTHER SWIMMING AFFILIATIONSETHNICITY (In accordance with US CensusBureau

(circle all that apply):DISABILITY:guidelines, you may make up to 2 choices if appropriate):

O. Junior High SchoolA.Legally Blind or Visually ImpairedQ.African American

1.Senior High SchoolB.Deaf or Hard of HearingR.Asian or Pacific Islander

2.YMCA / YWCAC.Physical Disability such asS.Caucasian

3.Collegeamputation, cerebral palsy,T.HispanicMAKE CHECK PAYABLE TO: Redding Swim Team

4.Summer Swim Leaguedwarfism, spinal injury,U.Native American

5.Mastersmobility impairmentV.Other

6.Disabled Sports OrganizationD.Cognitive Disability such asW.DeclineSUBMIT APPLICATION & PAYMENT TO YOUR CLUB

7.Water Polomental retardation, severeand MAIL TO:

  1. Nonelearning disorder, autismRedding Swim Team

P.O. Box 992112

If joining to participate in a learn to swim program, please check here. Redding, CA96099-2112

246-2666

YEAR LAST REGISTEREDIf you swam with another club in 2008, you must also complete

and submit the Sierra Nevada Swimming Change/Transfer form

SIGN

HEREX

SIGNATURE OF ATHLETE, PARENT OR GUARDIAN

------

Please, Circle the pool you would like to participate at:

> Youth Program (5-18 years old) - Redding Aquatic Center 10:00 -11:00am (Mon-Thurs) or

> Youth Program (5-18 years old) - ShastaCollege at 11:00 - 12:00 pm (Mon-Thurs) or

> Youth Program (5-18 years old) - ShastaCollege at 5:00 - 6:00 pm (Mon-Thurs) or

> High School Program (8th Grade & High School) at 8:00 – 9:30 am (Mon – Thurs)

Please circle your T-Shirt Size YXSYSYMYLASAMALAXL