2024 NCS IMX Camp Athlete Application Form
CAMP FEE:

I understand that this application is not complete until I submit payment of $110 for the IMX Camp fee using the PAYPAL link below.  IMX CAMP FEE IS NON-REFUNDABLE.

SUBMIT PAYPAL PAYMENT (click the following link to connect to the IMX PayPal page)


CONSENT and RELEASE STATEMENT:

I agree to allow my child to participate in the 2024 IMX Camp in Greensboro on Saturday, January 20, 2024. I further agree to release from all liability USA Swimming, Inc., NC Swimming, Inc., the event organizers, staff, manager, chaperones, and facility host Greensboro Aquatic Center for any and all injuries suffered by my child during the weekend camp. I understand that if my child violates the NCS Code of Conduct while on this trip that he or she can be dismissed immediately from the camp and that I am responsible for providing my child with transportation to and from the IMX Camp activities.  Further I authorize medical personnel to treat my child should an emergency arise and medical care be needed.

2024 NCS IMX CAMP CODE OF CONDUCT

APPLICATION DEADLINE:  November 28, 2023

Sign in to Google to save your progress. Learn more
Email *
Parent Electronic Signature *
I have read and agree to all of the above - type in your full name
Athlete Electronic Signature *
I have read and agree to all of the above - type in your full name
Athlete's Last Name *
Athlete's First Name *
Street Address *
City/State/Zip *
Home Phone *
Parent's Cell Phone *
Athlete's NC Swimming Club *
Athlete's Current Club Coach *
Parents'/Guardians' Name(s) *
Age Group *
Age Group that the swimmer has been assigned to for the camp
Athlete's T-shirt size
All apparel is unisex
Clear selection
Athlete's  Fleece Jacket size *
All apparel is unisex
Emergency Contact Name *
Emergency Contact Phone Number *
Doctor's Name *
Doctor's Phone Number *
Medical Insurance Carrier and Member Number *
Known Medical Conditions or Allergies (including food allergies) *
List any special dietary needs or restrictions *
 A payment for the $110 Camp Fee has been paid through PayPal. *
Required
I understand that the Camp Fee is non-refundable. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms