Participant's Name *
Participant's Name
Team Registering For
Participant Status *
Participant's Birthdate *
Participant's Birthdate
Gender *
Swim Team Age Group (if registering for Swim Team)
Dive Team Age Group (if registering for Dive Team)
Membership Type *
Please note that participants must have a FULL SEASON, FAMILY, MEMBERSHIP in order to be eligible to participate on the PVSC Swim and Dive Teams. Weekend/Holiday Memberships as well as individual memberships, are not valid for participation.
Primary Contact Number *
Primary Contact Number
Secondary Contact Number
Secondary Contact Number
Please note any special medical information (allergies), behaviors, or family situations that coaches and management should be aware of. This information will be kept confidential and only will be shared on a need-to-know basis.
Emergency Contact (if parent(s) cannot be reached) *
Emergency Contact (if parent(s) cannot be reached)
Emergency Contact Number *
Emergency Contact Number
Volunteer Agreement *
Photo Release
I authorize the PVSC to use photographs of my child that were taken at swim meets or other swim team functions. I recognize that these photos may be posted on the team Facebook and other social media outlets, used by news media, or used by the PVSC for promotional purposes. *Participants' names WILL NOT appear on social media
Please type your first and last name in the box provided as a digital signature for consent to participate and to acknowledge that you have read the requirements of the PVSC Swim & Dive Teams.
Date *
Date