Family Contact Info

Please enter the primary contact information for your family.

Additional Parent Contact Info

Please provide contact information for a second parent, if applicable. This person will serve as the secondary contact in the event of an emergency.

Emergency Contact Info

Provide information for an alternate emergency contact.

Provide additional information for use in an emergency.

Swimmer Information




Consent to Participate

By selecting "I agree" below and submitting this electronic form, I/we, the above named parent(s) or guardian(s) of the above-named child(ren), do hereby give my/our consent for participation in the training and competitive meets of the Southwest Swim League on the Falls Pointe Swim Team, which will provide a supervised competitive swim program. I/we, the parent(s) or guardian(s) of the above child(ren), do hereby give my/our approval for participation in all of the scheduled activities during the Falls Pointe Swim Team season. I/we do further release, absolve, and hold harmless Southwest Swim League and the Falls Pointe Swim Team and the Officers and Coaches of both organizations.

In case of injury to my/our child(ren), I/we hereby waive all claims against Southwest Swim League, the Falls Pointe Swim team, and swim team organizers, sponsors, or any of the supervisors appointed by them. I/we likewise release from responsibility any person transporting my/our child(ren) to and from activities. I/we also certify that my child(ren) is in good health and has no known disabilities which would keep him/her from participating this summer in the Falls Pointe Swim Team practices, meets, and other activities.

Photo Release Authorization

I hereby authorize Falls Pointe Swim Team to publish the photographs and videos taken of me and/or the undersigned minor children, and our names, for use in Falls Pointe Swim Team’s printed publications, website, Falls Pointe Facebook page, and “Swimmer of the Week” events.

Medical Treatment

Indicate your consent or refusal to consent to medical treatment.

CONSENT: In the event reasonable attempts to reach me or other parent or guardian at at the above indicated phone numbers have been unsuccessful, I hereby give my consent for: 1) the administration of any treatment deemed necessary by the above indicated Doctor or Dentist or, in the event the designated preferred doctor or dentist is not available, by another licensed doctor or dentist and 2) the transfer of the child to the above indicated hospital or any other hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed doctors or dentists concurring in the necessity of such surgery are obtained prior to the performance of such surgery. Facts concerning the child’s medical history including allergies, medications being taken and any physical impairment to which a physician should be alerted are listed above.

REFUSAL TO CONSENT: I do not give my consent for medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish the Falls Pointe Swim Team to take no action.

I/we agree that by checking the box above and typing my name below, this form serves as an electronic signature and confirmation that I/we have read and agree to all conditions stated herein.