Evolution Aquatics Stroke Clinic Registration
If you have any questions please call us at 704-949-1555 (leigh@evolutionaac.com) or if you are interested in private (or group) swim lessons email us at swimacademy@evolutionaac.com.
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Email *
Swimmers must be able to swim independently horizontally for at least 10 yards (no dog paddle).  
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SAT APRIL 1 (2:15p)
SUN APRIL 16 (3:15p)
SAT APRIL 22 (1:00p)
SUN APRIL 30 (2:00p)
SAT MAY 6 (2:15p)
SUN MAY 14 (3:15p)
Choose dates:
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SAT APRIL 1 (1:00p)
SUN APRIL 16 (2:00p)
SUN APRIL 23 (3:15p)
SAT APRIL 29 (2:15P)
SUN MAY 7 (2:00p)
SAT MAY 13 (1:00p)
Choose dates:
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SUN APRIL 2 (3:15p)
SAT APRIL 15 (2:15p)
SUN APRIL 23 (2:00p)
SAT APRIL 29 (1:00p)
SUN MAY 7 (3:15p)
SAT MAY 13 (2:15p)
Choose Dates:
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SUN APRIL 2 (2:00p)
SAT APRIL 15 (1:00p)
SAT APRIL 22 (2:15p)
SUN APRIL 30 (3:15p)
SAT MAY 6 (1:00p)
SUN MAY 14 (2:00p)
Choose Dates:
Total # Clinics Selected (you can register more at a later date if needed) *
Age Group Swimmer will compete this summer *
Swimmer's First Name *
Swimmer's Middle Name *
Swimmer's Last Name *
Swimmer's Date of Birth *
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Swimmer's T-Shirt Size *
Mailing Address *
Parent/Guardian #1 Name (First & Last) *
Parent/Guardian #1 Contact Telephone *
Parent/Guardian #2 Name (First & Last)
Second Email address (optional) not listed above:
Parent/Guardian #2 Contact Telephone
With which Summer League team is your swimmer affiliated? *
How did you hear about the our clinics? *
Is your swimmer currently or have they in the last 12 months been registered with a year-round USA Swimming club? *
Tell us a little about your swimmer's experience with competitive swimming. *
Does your swimmer have any known medical conditions or allergies that we need to be aware of? *
Please check off the items that your swimmer WOULD NEED (does not have) for participation in Swimming. Swimming items available for purchase in the Evolution Pro Shop. *
Required
Medical Release Waiver: certify that I am the parent or legal guardian for my child(ren). I hereby give my permission for any supervisor, coach or other team administrator associated with the Evolution Aquatics or Aquatics Performance of Charlotte to seek and give appropriate medical attention for our child(ren) in the event of accident, injury, illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment. INITIAL BELOW *
Liability Waiver: hereby waive, release and forever discharge Evolution Aquatics or Aquatics Performance of Charlotte and associated supervisor, coach or other team administrator from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Evolution Aquatics or Aquatics Performance of Charlotte activities, whether or not damages or loss is due to negligence. I hereby acknowledge that my children is (are) physically fit and capable of participation in all Swim Team activities.By registering my child(ren) with the Evolution Aquatics, I agree to participate (or allow my child(ren) and family members to participate) in the Evolution Aquatics, and hereby release Evolution Aquatics or Aquatics Performance of Charlotte, its directors, officers, agents, coaches, and employees from liability for any injury that might occur to myself (or to my child(ren) and family members) while participating in the Evolution Aquatics program, including travel to and from training sessions, swim meets or other scheduled team activities.I agree to indemnify and hold harmless the above mentioned organizations and/or individuals, their agents and/or employees, against any and all liability for personal injury, including injuries resulting in death to me, my child(ren) and/or other family members, or damage to my property, the property to my child(ren) and/or other family members, or both, while I (or my child(ren) or family members) participating in the Evolution Aquatics program. INITIAL BELOW *
Terms of Agreement: Evolution Aquatic & Activity Center and its co-organizers are not responsible for lost or damaged personal property. All scheduled events are subject to change.  I understand that no fees will be refunded or transferred unless a child is unable to participate due to an accident or illness with accompanying physician's note.  Children's photos and quotes may be used for publicity purposes,  In case of an emergency, I hereby authorize my child to be treated by Certified Emergency Personnel (i.e. EMT, First Responder, and/or physician).  Please initial below. *
Photo Release: I hereby give permission for my child to be photographed at Evolution Aquatics & Activity Center.  I understand the photos will be used for promotional purposes.  I understand that although my child's photograph may be used for advertising, his or her identity will not be disclosed.  I do not expect compensation and that all photos are property of NOMAD Aquatics & Fitness and its affiliates.   Please initial below. *
COVID Acknowledgement and Waiver: Evolution Aquatic & Activity Center COVID-19 Waiver Evolution Aquatic & Activity Center cannot prevent participants from becoming exposed to, contracting or spreading COVID-19 while participating in this camp.  It is not possible to prevent against the presence of the virus.  Therefore, if you choose to participate in this camp, you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19. BY ATTENDING OR PARTICIPATING IN THIS CAMP, YOU VOLUNTARILY ASSUME ALL RISKS ASSOCIATED WITH EXPOSURE TO COVID-19 AND FOREVER RELEASE AND HOLD HARMLESS AQUATIC PERFORMANCE OF CHARLOTTE CORP., NOMAD AQUATICS & FITNESS AND EACH OF THEIR OFFICERS, DIRECTORS, AGENTS, EMPLOYEES OR OTHER REPRESENTATIVES FROM ANY LIABILITY OR CLAIMS INCLUDING FOR PERSONAL INJURIES, DEATH, DISEASE OR PROPERTY LOSSES, OR ANY OTHER LOSS INCLUDING BUT NOT LIMITED TO CLAIMS OF NEGLIGENCE AND GIVE UP ANY CLAIMS YOU MAY HAVE TO SEEK DAMAGES, WHETHER KNOWN OR UNKNOWN, FORESEEN OR UNFORESEEN, IN CONNECTION WITH EXPOSURE, INFECTION, AND/OR SPREAD OF COVID-19 RELATED TO PARTICIPATION IN THIS CAMP. Please initial below. *
$25 Registration Due - covers 1 year of programs (camps & lessons) *
Guardian Signature *
Printed Name of Parent/Guardian *
Date Submitted *
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