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Registration 2019

Please register both parents if applicable.

Parent/Guardian Information

At least one parent/guardian registration is required.
New accounts will be sent an email confirmation message with instructions to setup a password.

At least one parent/guardian email address must be provided.
Check the boxes to indicate which parent/guardians should receive team-wide emails.

First Name * Last Name * Email Address *
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Primary Phone

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Athlete Information

Enter the information for each athlete being registered below. At least one Athlete registration is required.

First Name * Preferred Name Middle Initial Last Name * Gender * Birth Date *
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Home Address

Additional Contact Numbers?

Would you like to add additional contact numbers besides the "primary phone" collected above? Please add them here.

Pool Membership/Eligibility

Swim team members must have full privileges to Sully Station Pool. Please indicate your status below. *

New to Team?

Is this your first season with Sully Swim Team? *

Referral?

If new this season, please list a team member who recruited or referred you. (If relevant)

Year Round Swimmer?

Please list each swimmer and his/her club team for any swimmers that participate in year-round USAS clubs.

Swimmer's Expected Graduation Date

Please list each swimmer's expected graduation year. *

Waiver/Release of Liability

As Parent/Guardian of the above-named minor(s), I grant permission for the swimmer(s) to participate in all activities of the Sully Station Swim Team, a Northern Virginia Swimming League (NVSL) member team.  I represent and warrant that my minor child/children participating on the Sully Station Swim Team are in good health and have no physical condition, ailment or disability which renders them unable to participate in vigorous physical activity.  For and in consideration of benefits derived from participation in the Sully Station Swim Team program, I understand that the risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist.  I assume all risks and hazards arising out of, or related to, such participation, including, but not limited to, transportation to and from such activiies, and do hereby indemnify, release and hold harmless the Sully Station Swim Team, its coaches, team representatives, volunteers, property manager, employees and agents, as well as the Northern Virginia Swimming League, from all claims of any kind whatsoever which may arise or hereafter accrue in conntectino with my child's/children's participation in activities of the Sully Station Swim Team.  I further grant permission for first aid to be given to my child/children in an emergency, and will be solely responsible for any medical costs which may arise.  I AGREE THAT THEY WILL ABIDE BY THE NORTHERN VIRGINIA SWIMMING LEAGUE CODE OF CONDUCT.

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Enter your initials to indicate acceptance: *