BRENHAM DOLPHIN SWIM TEAM

www.brenhamdolphins.com

REGISTRATION / SWIMSHOP PURCHASES

MONDAY, MARCH 7, 2005

BLUE BELL AQUATIC CENTER

5:00 – 7:00 P.M. “COME & GO”

FEES FOR EACH FAMILY:

1 SWIMMER - $80.00 Scholarships are available! Any child eligible

2 SWIMMERS - $150.00 to receive a free lunch in school qualifies!

3 SWIMMERS - $215.00

4 SWIMMERS - $280.00

CHECKS FOR THESE FEES NEED TO BE MADE OUT TO BRENHAM DOLPHINS

Upon payment of your registration fee, you will receive a $30.00 certificate for each swimmer which can be applied toward an Aquatic Center pass for a two-month or longer period. These certificates need to be used prior to 3-1-06.

SwimShops of the Southwest will have team swimsuits, goggles, and practice swimsuits available for purchase at the Aquatic Center on Monday, March 7 ONLY. After that day, you will need to purchase them at the shop (5010-M Louetta, Spring, TX 77379) or by mail (phone: 1-800-392-2221).

Head Coach – Ellen Flenniken

Assistant coaches—will be announced later

MANDATORY TEAM PARENTS MEETING

MONDAY, March 28, 2004

6:00 P.M.

First Baptist Church Activity Center

All parents are required to attend this important meeting!

(please fill out and bring to registration, March 7^th,5-7pm, Blue Bell Aquatic Center)

BRENHAM DOLPHIN SWIM TEAM 2005

Swimmer’s Name ____________________________ Date of birth __________

April clinic: Write “1” in blank for 1^st choice & “2” in blank for 2^nd choice

M/W _____ T/Th _____

Sex ___ Age as of 5-31-05 ____ T-shirt Size: Youth S M L XL Adult S M L XL

Parent/Guardian _________________________ _________________________

(Mom) (Dad)

Address __________________________________________________________

Phone __________________ ____________________ ___________________

(Home) (Work) (Cell)

E-mail ___________________________________________________________

Emergency Contact _________________________________ ______________

(Name/Relationship) (Phone)

Medical History (Any physical limitations) ________________________________

__________________________________________________________________

Health Insurance Company ___________________________________________

Group/Policy Number ______________________ Phone ____________________

PARENTAL WAIVER AND CONSENT FORM

As the parent or legal guardian of the child above named, I hereby give my full consent and approval for my child to participate as a team member on the Brenham Dolphins. I understand that there are certain risks of injury inherent in the practice and play of this sport, as well as in traveling and other related activities incidental to my child’s participation, and I am willing to assume these risks on behalf of my child. I hereby certify that my child is fully capable of participating in this sport and that my child is healthy and has no physical or mental disabilities or infirmities that would restrict full participation in these activities, except as listed above. In addition to giving my full consent for my child’s participation, I do hereby waive, release and hold harmless the non-profit group Washington Country Swim Club, Inc, dba the Brenham Dolphins, its officers, coaches, sponsors, supervisors and representatives for any injury that may be suffered by my child in the normal course of participation in the designated sport and the activities incidental thereto, whether the result of negligence or any other cause.

Parent/Guardian signature ___________________________________________

CONSENT FOR MEDICAL TREATMENT (MINOR)

As the parent or legal guardian of the above-named child, I hereby give consent for emergency medical care prescribed by a duly licensed doctor or dentist. This care may be given under whatever conditions are necessary to preserve the life, limb, or well being of my dependent.

Parent/Guardian signature ___________________________________________