Children's Information
  Child's FULL Name   
         Preferred Name

  Birthdate Age 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Boy Girl (a copy of Birth Certificate is needed)

  Have you ever swam on another Gwinnett Swim League Team? Yes No
  If yes, What was the team Name and Location?

Parent Information
Email               

  First Name             Last Name     

Spouse or Other Guardian Information:

  First Name              Last Name  

Address           
Address cont'd 

City               State    Zip

Home Phone     Work Phone

Emergency Contact and Number 

Parent Volunteers are needed. Where are you best utilized for Volunteer Duties? Please list which duties for which you prefer to volunteer;Starting, Bullpen, Setup/Cleanup, Timing, Snackbar, Age Group Coordinator, Score keeping, or anything else!

Medical Release & Other Information
for

Check all that apply:
Cardiac Problems Asthma Seizures Diabetes
Chronic Ear Problems Chronic Illnesses
If any of the above are checked, a statement from the treating physician must be provided, clearing the child to swim.
 Please list any other medical problems such as Allergies / Medications, Other info.

Physician's Name      Physician's Number 
Insurance CompanyName and Policy Number
Insurance Company Policy Number

I, ,agree to release Youth Swimming, Inc., Walton Waves, Inc. , Youth Athletic Recreation Company, Inc., & Staff, Bluesprings Sports Ranch & Staff from any responsibility for property damage, illness, or injury incurred by my child, , at Bluesprings. I agree to allow Walton Waves Swimming 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. I also assume responsibility for the payment of any such treatment. Youth Swimming, Inc., Walton Waves, Inc. , Youth Athletic Recreation Company, Inc., & Staff, Bluesprings Sports Ranch & Staff from will not be held responsible for property damage, illness, or injury incurred by my child at Bluesprings.
    Website information: Swimmers names and pictures may appear on or through our website www.waltonwaves.com in the form of meet entries, meet results, rosters, as well as team pictures and action photos.
     In case I cannot be reached, any of the following persons are designated to act on my behalf: 
* Coach * Assistant Coach * Designee of the Walton Waves/Youth Swim Team

Signed _____________________________________Date __________________
Please make checks payable to : Youth Swimming
You can mail registration form to:
Youth Swimming
1810 Kristins Way
Loganville, Georgia 30052
If you have any further questions please call (770) 466-8353