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2025 Swim Team Consent & Medical Form
2025 Swim Team Consent & Medical Form
Your Contact Info
Provide your name, email and phone number (if not auto-populated).
Are you a member? Please
sign in here
instead.
Number of children you are enrolling on swim team (ages 5 through 18)
1
2
3
4
5
List how many children you are enrolling that will be a Shrimp, House or Team League.
Example: 1 Shrimper, 2 House, 1 League
Child 1 First Name
Child 1 Last Name
Child 1 Age
Please enter the birthday and age the child will be by June 1, 2025.
Child 1 T-shirt size
Enter their size
Youth XS
Youth Small
Youth Medium
Youth Large
Youth XL
Adult XS
Adult Small
Adult Medium
Adult Large
Adult XL
Child 1 Gender
Boy
Girl
Child 1 allergies or other needs
List any important information we should know
Child 2 Information
Child 2 First Name
Child 2 Last Name
Child 2 Age
Please enter the birthday and age of this child when begins on Wednesday Mar 01, 2023.
Child 2 T-shirt size
Enter their size
Youth XS
Youth Small
Youth Medium
Youth Large
Youth XL
Adult XS
Adult Small
Adult Medium
Adult Large
Adult XL
Child 2 Gender
Boy
Girl
Child 2 allergies or other needs
List any important information we should know
Child 3 Information
Child 3 First Name
Child 3 Last Name
Child 3 Age
Please enter the birthday and age of this child when begins on Wednesday Mar 01, 2023.
Child 3 T-shirt size
Enter their size
Youth XS
Youth Small
Youth Medium
Youth Large
Youth XL
Adult XS
Adult Small
Adult Medium
Adult Large
Adult XL
Child 3 Gender
Boy
Girl
Child 3 allergies or other needs
List any important information we should know
Child 4 Information
Child 4 First Name
Child 4 Last Name
Child 4 Age
Please enter the birthday and age of this child when begins on Wednesday Mar 01, 2023.
Child 4 T-shirt size
Enter their size
Youth XS
Youth Small
Youth Medium
Youth Large
Youth XL
Adult XS
Adult Small
Adult Medium
Adult Large
Adult XL
Child 4 Gender
Boy
Girl
Child 4 allergies or other needs
List any important information we should know
Child 5 Information
Child 5 First Name
Child 5 Last Name
Child 5 Age
Please enter the birthday and age of this child when begins on Wednesday Mar 01, 2023.
Child 5 T-shirt size
Enter their size
Youth XS
Youth Small
Youth Medium
Youth Large
Youth XL
Adult XS
Adult Small
Adult Medium
Adult Large
Adult XL
Child 5 Gender
Boy
Girl
Child 5 allergies or other needs
List any important information we should know
Additional Questions
Additional Contact name (not already listed)
Provide the name for any additional parents or guardians.
Additional Contact phone
Provide the phone number for any additional parents or guardians.
Child's Primary Care Physician name
Please provide the doctor's name or the physician practice name for your child(ren).
Child's Primary Care Physician phone
Please provide the doctor's phone number for your child(ren).
FOR REGISTERING MULTIPLE CHILDREN: If you need to identify different doctors for multiple children, please use this space. Identify the child and their doctor.
Write in your answer below...
Health Insurance Carrier
Please provide your insurance carrier and group number.
Hospital preference:
Novant Presbyterian
Atrium Carolinas Medical Center
PARENT/GUARDIAN AGREEMENT: As a Parent/Guardian of a Rama Swimmer, I agree that I will participate in the meets by signing up to assist in a minimum of two (2) meets each season.
Yes I will participate as requested
Yes I will participate as requested
MEDICAL DISCLAIMER:
I understand that Rama Swim Club, Inc. assumes no responsibility for injuries or illness which my child may sustain as a result of his/her condition or resulting from his/her participation in any swim team activities. I expressly acknowledge that I assume the risk for any and all injuries that may result from his/her participation in these activities. I hereby voluntarily release, indemnify, hold harmless and discharge Rama Swim Club, Inc. and its officers, directors, agents, and employees from all claims for injury, death, loss, or damage which my child may suffer as a result of his/her participation in these activities. I hereby give permission to the medical personnel identified above or selected by Rama Swim Club, Inc. to order x-rays, tests, treatment, and to release any records necessary for insurance purposes and to provide or arrange any necessary related transportation for me or my child. In the event that I cannot be reached for an emergency, I hereby give the physician listed above or selected by club personnel, to secure and administer treatment, including hospitalization, for my child. I understand that no accident or medical insurance is provided with these activities.
I have read and understand fully the content of the medical disclaimer and information provided abov
I have read and understand fully the content of the medical disclaimer and information provided abov
ELIGIBILITY RULES:
It is required by Rama Swim & Racquet Club that all family members participating on the swim team must pay their dues prior by April 30, 2025 to be eligible to swim on the team. Please contact Club President if you have any questions about your balance. Per the QCSL Eligibility Rules: To be eligible for the current season, swimmers must be 18 years or younger on the May 31 that falls during, or immediately prior to the start of, the current season.
I have read and understand fully the eligibility rules provided above.
I have read and understand fully the eligibility rules provided above.
SWIMMER BEHAVIOR:
All swimmers are held to high standards of behavior and sportsmanship at all times. We will be respectful of ALL coaches and adult volunteer requests at all times. We will build up our teammates. At meets, we will remain in the pool until all swimmers in their event are done, and congratulate nearby swimmers when they finish. At meets, we will clean up after ourselves. At meets, we will arrive at the ready-benches on-time, knowing that if we can't be fully ready for our event, we may be scratched from our heat/swim event. This is at the discretion of the swim team coach(es), manager, and/or the hosting swim team leadership.
I have reviewed this information with my swimmer.
I have reviewed this information with my swimmer.
PARENT/GUARDIAN/SPECTATOR GUIDELINES:
Per QCSL regulations, no alcohol consumption is allowed during swim league sanctioned times (during meets and practice). The Rama Pirates Swim Team also asks that you monitor your swimmer's whereabouts during meets to ensure they get to their event early for lineup. Finally, be advised that the Pirates' Cove and Baby Pool areas are closed during meets due to liability and safety concerns.
I have reviewed this information and agree to these guidelines
I have reviewed this information and agree to these guidelines
Submissions closed as of Monday, Jun 30, 2025
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