CCAC
dba DIVE ATLANTA
2001 TEAM REGISTRATION FORM
Diver’s
Name:_______________________________________________ M:____ F:____ Age:______
Birthdate:________________ Have you ever been registered through US
Diving before?______. If yes,
Please
give name of club and last year
registered:_____________________________________________
Parent
Name(s):________________________________________________________________________
Mailing
Address:_______________________________________________________________________
E-Mail:________________ Home Phone: ( )_____________
Work Phone: (
)_____________
FINANCIAL AGREEMENT:
1.
Dive
Atlanta’s annual registration fee is due at initial sign-up (and every November
thereafter). This fee includes registration
with US Diving and a subscription to US Diving Magazine. The team allows prospective members to learn
about the diving, by allowing observation only.
2.
Monthly
fees of $100 are due on or before the first of each month. A late charge of $10 (per diver) will be
assessed for payments received after the 10th of each month. Initial monthly fees will be prorated for
divers registering after the 15th of the month. There will be NO other prorated fees. (Fees will be suspended at the beginning of
a month for injured or otherwise restricted by a physician from practicing, but
only with a physician’s note. If the
diver resumes practice after the 15th, the rules for prorating
apply).
3. Coach expenses for away meets are not covered in the regular monthly fees. As the team operates on a non-profit basis, no team funds are available to cover these expenses. These expenses are shared by all divers participating in the meet and is generally handled through an escrow account process, but periodically may require additional collections for unforeseen events or in order to keep the team operating. The Parent’s Club and the Board will use their best efforts to keep fees to a minimum.
4.
The
team requires a 30 day written notice (to the coach), prior to discontinuing diving,
otherwise the diver’s parent/guardian will be required to pay for the full
months fees.
I
have read and understand this agreement and do agree to abide by these terms:
_______________________________________________ __________________________________ _______________
Parent/Guardian Signature Print Name Date
EMERGENCY
INFORMATION: to be completed by parent or
guardian, (please print).
I (We) authorize to consent to any examination, anesthetic, X-ray, medical or surgical diagnosis or treatment and/or hospital care to be rendered to the minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice when efforts to contact me (us) are unsuccessful.
I, (We)_________________________________, request that the following information be considered when medical treatment is rendered to my (our) child, ____________________________ age______. Known Allergies:_________________________ Current Medication:___________________________ Medical History:____________________________________________
Physician’s Name:___________________________ Phone:__________________ Name of other relative, if parent/guardian cannot be reached:___________________________ Phone:__________________ Relationship to child:_________________.
Amateur Athletic Waiver of Liability: Dive Atlanta, practice facilities of Dive Atlanta, the coaches, assistants and employees of such, are hereby released and discharged from any and all claims, actions, causes of action or right of claim to damages, which might arise because o the participation of (diver’s name) ______________________________________ in any part of the 19____ Dive Atlanta program, or in any or all associated activities, by the undersigned parent or guardian and any and all heirs and administrators.
_________________________________________________________ _____________________________________
Parent/Guardian Signature Date
INSURANCE INFORMATION:
Ins. Co. Phone:_________________Policy
#:______________________Group #:___________________
Billing
Address:________________________________________________________________________
Insurance Co.:____________________________________ Insured:_____________________________
Ins. Co. Phone:_________________Policy
#:______________________Group #:___________________
Billing Address:________________________________________________________________________
PARENT/GUARDIAN
AGREEMENT:
1. The team highly encourages Parent/Guardian to Coach communication. Parent/Guardian agrees to arrange discussions with coaches outside practice time in order to ensure divers will get the full benefit of the practice session. The coach will generally have time for discussions before and after practices, or through individual arrangements.
2. Parent/Guardian agrees to accompany the diver to all meets whenever possible. If the parent/guardian is unable to attend, he is responsible for arranging for supervision by another adult at the meet. The coach is not a chaperone.
3. Dive Atlanta may host several meets throughout the year. These meets require involvement from everyone on the team and in the Parent’s Club. Parent/Guardian and divers agree to participate in hosting the meets.
4. Parent/Guardian agrees and understands if suspension from practice becomes necessary due to discipline reasons monthly fees will continue to assess. It is the parent/guardians responsibility to ensure their diver understands he/she cannot disrupt practices for others.
5. Parent/Guardian agrees to be responsible for damages to practice facilities and equipment by divers intentional destruction of property.
________________________________________ _____________________________________ ______________________
Parent/Guardian Signature Print Name Date