Rockdale County Swim League
Deer Run Dolphins
Registration for 2012
Are you a Member of the Deer Run Recreation Corporation? Yes No

Parent Name : A value is required. A value is required.
  Address:             A value is required.
Address cont'd: A value is required.
City: A value is required. State: A value is required.Minimum number of characters not met. Zip: A value is required.Invalid format.

(For Phone Numbers enter numbers only...page will format)
Home Phone : A value is required. Cell Phone: A value is required. Work Phone: A value is required.

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Emgergency Name & Contact Phone Number:

Swimmer's
First Name
Swimmer's
Last name
BirthDate
(mm/dd/yyyy)
02/02/1998
Age
(as of 6/1/12)
Gender
T-Shirt
 Official
Use

Records and photo Release Permission: (Please Check one) :

My child's/ children's image(photograph) and swim records may be displayed on the website of an individual team, the website for the Rockdale Swim League, and local newspapers.

2012 Rockdale Swim League Rules and Regulations Waiver Statement

I have received and read the 2011 Rockdale Swim League rules and Regulations, I understand that these Rules and Regulations will be followed during each dual meet and the final County swim meet. I understand the Rockdale Swim League and its Board are volunteer organizations which exist for the sole purpose of providing fun, recreational and competitve swimming. In the event of an accident, misinterpretation of the Rules and Regulations, misunderstanding or other similar circumstance, I agree to hold blameless the Rockdale Swim League, the Rockdale Swim League Board members, the individual Swim Team Representatives, Coaches and Team Volunteers during any swim team practice, dual meet, or authorized Rockdale Swim League event. I also agree that, in the event of an emergency, the Rockdale Swim League, the Rockdale Swim League Board Members, the individual Swim Team Representatives, Coaches, and Team Volunteers may seek emergency assistance for my child/children. In the event of an emergency, I hereby authorize any needed emergency medical care. I further agree to be fully responsible for all medical expenses incurred during the treatment of my child/children.

Deer Run Waiver
I also agree to release Deer Run Recreation Corporation, from any responsibility for property damage, illness, or injury incurred by my child/children at Deer Run. I agree to allow Deer Run Dolphins Staff, or another authority to administer First Aide for my child, if necessary. I, the undersigned, will be responsible for any & all costs of medical attention and/or treatment. I hereby give permission for any and all medical attention to be administered to my child, in the event of accident, injury or sickness, under the direction of the person(s) below, until such time as I may be contacted. . In case I cannot be reached, any of the following persons are designated to act on my behalf: * Coach * Assistant Coach * Designee of the Deer Run Dolphins Swim Team. I also assume responsibility for the payment of any such treatment. Deer Run Recreation Corporation will not be held responsible for property damage, illness, or injury incurred by my child at Deer Run.

Parent Signature _______________________________ Date __________

Please make checks payable to : DRRC. Note..**NO REFUNDS AFTER FIRST TEAM PRACTICE **

Medical Information

Physician's Name      Physician's Number 


Please list any medical problems such as Allergies, Asthma, etc.. / Medications, Other info.