ROSELLE RACERS SWIM TEAM - FAMILY INFORMATION, ROSTER & PHOTO

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Family Last Name *

Participant's Address *

Home Phone *

Home Park District *

Father's Name (First & Last) *

Father's Cell Phone

Father's Work Phone

Father's Email Address *

Choose to include/exclude from team email updates *

Father's Email

YES - include this email on team email updates

NO - Exclude this email on team emai updates

Mother's Name (First & Last) *

Mother's Cell Phone *

Mother's Work Phone

Mother's Email Address *

Choose to include/Exclude from team email updates *

Mother's Email

YES - Include this email on team email updates

NO - Exclude this email on team email updates

Who does the participant live with? *

Father

Mother

Both

Other

Emergency Contact's Name (Parents will be called first): *

Emergency Contact Phone Number *

ADDITIONAL TEAM JOBS:

Many hands make light work - we need your help!! Please check if you are interested in helping out with any of the following extra jobs:

Photographer (Take pictures of an assigned age group during season)

Conference Breakfast (Organize/help with annual conference b-fast)

Pool/Potluck Party Team (Organize/help with annual pool/potluck party)

Parade Chaperone (Meet/escort swimmers in Rose Parade)

End of Season Banquet Team (Organize/help with end-of-season banquet)

Announcer (Home Meets)

National Anthem (sing the National Anthem prior to home meet)

Additional jobs, as needed

PHOTO RELEASE: *

Occasionally the Roselle Park District and/or the Roselle Racers Swim & Dive Team allows photo coverage of swim meets and events. I/we give permission for participants listed below picture to be used in informational news coverage and/or on the Roselle Park District and/or Roselle Racers Swim & Dive Team websites. In any of these publications an athlete's last name will not be used in conjunction with his/her picture unless prior approval from the parent/guardian is received.

I AGREE - By checking this box, you are either a Parent or Guardian of this/these child(ren) and approve the Photo Release statement

I DISAGREE - By checking this box, you are either a Parent or Guardian of this/these child(ren) and do NOT approve the Photo Release statement

Required

PARTICIPANT #1

Participant's Name(s) - (First & Last) - {as to be listed on ribbons & trophy} *

Participant #1

Gender? *

Participant #1

Male

Female

Birth Date *

Participant #1

YYYY

T-Shirt Size (Participant Size) *

Participant #1

PARTICIPANT #2

Participant's Name(s) - (First & Last) - {as to be listed on ribbons & trophy}

Participant #2

Gender?

Participant #2

Male

Female

Clear selection

Birth Date

Participant #2

YYYY

T-Shirt Size (Participant Size)

Participant #2

PARTICIPANT #3

Participant's Name(s) - (First & Last) - {as to be listed on ribbons & trophy}

Participant #3

Gender?

Participant #3

Male

Female

Clear selection

Birth Date

Participant #3

YYYY

T-Shirt Size (Participant Size)

Participant #3

PARTICIPANT #4

Participant's Name(s) - (First & Last) - {as to be listed on ribbons & trophy}

Participant #4

Gender?

Participant #4

Male

Female

Clear selection

Birth Date

Participant #4

YYYY

T-Shirt Size (Participant Size)

Participant #4

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