In case of an emergency, the parent contact information listed above will be utilized first.  Please provide two additional emergency contacts below.

I, the undersigned, hereby certify that the above named swimmer(s) has been recently examined by a physician, is physically fit, and has no pre-existing condition which would prohibit participation in the strenuous physical program the Macungie Bear Swim Team (The Team).  I authorize the Team coaches or its representatives to obtain emergency medical treatment for the above named swimmer(s) if deemed necessary, and agree not to hold the Team, its directors, coaches, staff, or their representatives in any way liable.  I have provided the administration with a list of any medications taken on a regular basis and the reason for taking them.  The Team has my permission to photograph, videotape, or film this swimmer(s) for promotional purposes.  I also hereby agree that my contact information can be distributed to other team members.