Name: Last Middle First / Date of Birth: / Age: / c Male / c Female
Medical Diagnosis/Medications:
Name: Last Middle First / Date of Birth: / Age: / c Male / c Female
Medical Diagnosis/Medications:
Name: Last Middle First / Date of Birth: / Age: / c Male / c Female
Medical Diagnosis/Medications:
FATHER INFORMATION / MOTHER INFORMATION
Name: / Name:
Mailing Address: / Mailing Address:
Primary Phone: / ð cell / ð home / ð work / Primary Phone: / ð cell / ð home / ð work
Secondary Phone: / ð cell / ð home / ð work / Secondary Phone: / ð cell / ð home / ð work
Email Address: / Email Address:
EMERGENCY CONTACT INFORMATION
Doctor: / Phone:
Emergency Contact: / Phone:
Registration:
One Swimmer $ 90.00
Two Swimmers $170.00
Each Additional Swimmer $ 50.00
(Registration may be paid by cash, check OR credit card) / Insurance:
$50.75 per swimmer – this online payment is REQUIRED by USA Swimming
It can be paid together with registration fees.
(Insurance may be paid by cash, check OR credit card)
Parent Help Fee: Each family is required to pay a $100.00 work deposit, which will be held (not cashed), then returned once a parent has worked at least 10 hours during the RBT Invitational meet. If less than 10 hours are worked OR no parent participation, the check will be cashed. (see Parent Handbook for details)
(This work deposit is payable by check only and must be separate from the registration fee.)
IMPORTANT!!!!! All fees must be paid in full before a swimmer is allowed in the pool.
Fees are NON-REFUNDABLE. There is a $20.00 fee for returned checks.
Parent/Guardian Signature: (By signing below you agree to all fees listed above.):
/ Date
Please Mail to: RB Tritons ATTN: Nancy
PO Box 145
Red Bluff, CA 96080 / Triton Use only:
Registration/Insurance Check# ______
Work Deposit Check# ______
2017 Photo Consent, Handbook & Parent help
Signature FORM
Complete this form at time of registration. This will be retained by the Triton Registrar.
Swimmer Name(s):
Permission to Use Photos
c Online & Newspaper: I hereby consent that the video, photos, electronic images and/or audio recordings of my child(ren) may be used by Red Bluff Tritons for Public Relations and Publicity purposes such as newspapers and the RBT website or Facebook page.
c Newspaper Only: I understand that his/her last name and residence might be used for publicity purposes such as Newspaper coverage of events which is also displayed on the newspaper’s website.
c NONE: I do NOT wish for my child(ren) to be in ANY video or photos for ANY Public Relations or Publicity purposes.
Sign
Date
Parent Handbook & Workbond
c I acknowledge that I have received the RBT Parent Handbook and agree to the terms and conditions, including, but not limited to the requirements of fulfilling work commitment for a refund of my Parent Help Fee/work bond. Failure to complete the commitment will result in a forfeit of the entire amount of the Parent Help Fee/work bond.
I understand that it is my responsibility to
ensure completion of the said
volunteer commitment. Please check a box below for your desired volunteer option.
Sign
Date
Runner BBQ Concession Ribbons Hospitality Setup/teardown Announcer Officiate Marshall Bull-pen