St. Luke's Academy

Inspiring Excellence

Seaside Aquatic Swimming Club

Registration Form

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Student's Name
Student's Address
Parent/Guardian Name
Emergency Contact Name
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe
Is the student prescribed an inhaler/ or medication? If yes, please explain any instructions

I hearby give my approval for my child's participation in any and all activities prepared by Seaside Aquatic Swimming Club. In exchange for the child's acceptance I

Parent/Guardian's Name

assume all risk and hazzards incidental to the conduct of the activities, its respective instructors, counselors, and representatives from any and all liability for injuries to said child arising out of travelling to, participating in, or returning from selected swimming sessions, In case of injury to said child, I hereby waive all claims against, including all coaches and affiliates, all participants, and, if applicable, owners

Parent/Guardian's Name