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									                                     WEST VIRGINIA AQUATICS
                                      REGISTRATION CONTRACT
                               Spring/Summer Long Course Season 2009
                                         (April 1st to July 31st)
                      Register online at
         Registration Checklist
         Please bring this form with you to registration

         ___ Completed Registration Contract
         ___ Read and Sign Terms & Conditions/Liability Form
         ___ Completed Medical Forms
         ___ Paid dues

Registration Details
The first day of practice and registration will be held on September 2nd 2008 for all groups at the WVU Natatorium. Please
bring with you this completed contract and the first payment due upon registration based on your child‟s group selection.
Please list all swimmers and groups on form. To ease the enrollment process, following is a summary of what is included in
your registration materials and those items that need to be completed upon registration.

• Registration Contract - please read and sign the following sections entitled “Terms and Conditions for Participation” and
“Parent Authorization and Release of Liability” in their entirety as this is a legally binding contract.

• Medical History/Consent to Emergency Care – please complete thoroughly and sign the authorization for care in the
event of an emergency.

• USA Swimming Athlete Registration Application – all swimmers must be registered with USA Swimming. A non-
refundable registration fee of $63 is required. USA Swimming registration cards are valid through the end of 2009.

• West Virginia Aquatics – Minors Waiver, Release and Indemnification Agreement is a requirement by the West
Virginia University – please read and sign.

** If we have the above information on file please just fill in at the top of each form “On File.” Please however re-submit the
Liability Waiver and sign.**

                                   Please KEEP this sheet for your reference
                               WEST VIRGINIA AQUATICS
                                 Spring/Summer 2009

Registration Information                                                Group*: __________

Swimmer Information:                                  Date of Registration: ___________

Swimmer Name(s): _____________________ _______________________ __________________
         (Last)                      (First)                 (Middle)

Address: _____________________________________________________________________

City: ___________________ State: __________ Zip: _________________

Home Phone: ____________________ Parent’s Cell:      _______________________

Family’s Email: ____________________________                 T-Shirt Size: _________

Date of Birth: ____________ School: _______________________ Grade: ___________

Billing Information:

Responsible Parent: _______________________________________________________

Address: ________________________________________________________________

City: _______________________________ State: _________ Zip: _____________

Parent‟s Name& Cell ________________________       _____________________________

Parent‟s Name & Work _______________________       ______________________________

Parent‟s E-mail ____________________________
WVA Aquatics Spring/Summer dues
Cudas             $180.00
Age Group         $220.00
Pre_senior        $260.00
Senior            $300.00                                               $_______.00
**There is a $10/month discount for 2nd swimmer                         $_______.00
**There is a $15/month discount for 3rd Swimmer                         $_______.00
** There is 50% of for 4th swimmer                                      $_______.00
USA Registration Fee $63.00 X #_______ Swimmers*                        $_______.00
Initiation Fee*                                                         $ 50.00
* USA Reg. & Initiation Fee for New Members only
Total:                                                                  $_______.____
I will be paying in a                                                   1 time payment____
                             Monthly billing available online only
Paid: __Check __Cash                                                    $_______.____
                                            WEST VIRGINIA AQUATICS
                                              Spring/Summer 2009

Terms and Conditions
Swimmer NAME(S): ________________________________                         Group(S): _________________________

Terms and Conditions for Participation in West Virginia Aquatics
1. You are committing to join West Virginia Aquatics for one full semester. Should a swimmer decide to discontinue
participation in the Swim Club, the unused portion of the season training dues are not refundable and any outstanding entry
fees are considered an obligation to West Virginia Aquatics and are payable upon termination of participation.

2. Training dues are to be paid at registration.

3. Any checks returned to West Virginia Aquatics will be subject to a $35.00 additional handling fee.

4. USA Swimming registration fee is not refundable and must be paid prior to the swimmer entering the water.

5. Meet entry fees are in addition to training fees and are billed as they occur. Meet entry fees are to be paid at the time of
registration for the meet. Entries will not be accepted without payment.

6. The club will host two swim meets, if not more, during the 2008 short course season. These meets are the largest fund-
raising activities conducted by the swim club. As such, the proceeds from these meets lower the fees charged to ALL
members of the club. As a result, it is necessary for each family to fully participate in supporting these meets. Failure to
volunteer the required session will result in a $50 fee to be assessed to your account with West Virginia Aquatics.

7. All swimmers who are members of West Virginia Aquatics are encouraged to participate at their highest level of
achievement in the championship meets (including relays). Meet participation is highly recommended but not required.
Meets are fun and an excellent way to meet people and have the team grow.

8. Each swimmer is required to purchase a West Virginia Aquatics team suit and cap and wear them for swim meets.

I understand and agree to the above terms and conditions of West Virginia Aquatics in exchange for the privilege of
my child, registered with this form, to participate in the activities and swimming program of West Virginia Aquatics.

Parent Authorization and Release of Liability
Emergency Authorization: I, the undersigned parent or legal guardian of the above swimmer, a minor, hereby designate the
coaches and the above named individual to act as my agents in the capacity of activity supervisors and vehicle drivers, and to
consent to medical, surgical, or dental examination and/or treatment on my behalf or until I can be contacted.

Disclaimer, Assumption of Risk and Waiver: I, the undersigned parent or legal guardian of the above swimmer
acknowledges that participation with WEST VIRGINIA AQUATICS is voluntary. West Virginia University shall not be
held liable for any injuries, damage, or other such loss, which the minor participant may incur while using the Natatorium
facility or participating with WEST VIRGINIA AQUATICS. I, the undersigned, specifically assume all risk of injuries,
damages, or other such losses, including death, while using WVU facility or participating with WEST VIRGINIA
AQUATICS, exercise or activity at WVU or on West Virginia University premises. I waive any and all claims against West
Virginia University, its trustees, officers, agents, employees, or those of the WEST VIRGINIA AQUATICS swim team, for
any such injuries, damages, or other such losses.

Parent/Guardian Signature: _______________________________                                   Date: ______________
                                           WEST VIRGINIA AQUATICS
                                             Spring/Summer 2009

Medical Forms

Physician:                                               Address:                                      Phone:

Dentist:                                      Address:                                      Phone:

Emergency Contact #1:                                    Relationship:                                 Phone:

Emergency Contact #2:                                    Relationship:                                 Phone:

Health Insurance Carrier:                     Policy/Group/Claim #:                         Phone:

Rx Drug Plan #:

Please indicate any allergies your child may have, any medication the child may be taking and any other facts to which a
physician or dentist should be alerted ________________________________________________________

Please answer each question below:

Has this athlete ever required hospitalization, surgery or had an injury or serious medical illness?            ____________
Explain: _____________________________________________________________________

Is this athlete now under the care of a physician?                                                              ____________
Explain: _____________________________________________________________________

Has any physician ever recommended or do you feel that there should be limits placed on this swimmer‟s
participation in competitive sports?                                                                            _____________
Explain: ______________________________________________________________________

Does this athlete wear contacts or glasses?                                                                     _____________

Has this athlete ever blacked out or lost consciousness during physical activity?                               _____________
Explain: ______________________________________________________________________

Consent to Emergency Care
I understand the WVA coaching staff will contact 911 if he or she deems it necessary. Furthermore, I understand that
reasonable attempts to contact me at the listed telephone numbers will be made.
I hereby give my consent for the administration of any treatment deemed necessary by Dr.________________________
(preferred physician) or Dr._______________________ (preferred dentist) or in the event the designated preferred
practitioner is not available, by another licensed physician or dentist; and 2. The transfer of the child to
____________________________ (preferred hospital) or any hospital reasonably accessible. This authorization does not
cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for
such surgery are obtained before surgery is performed

Parent/Guardian Signature: ________________________ Date: ___________________
                                               WEST VIRGINIA AQUATICS

                                   Spring/Summer Long Course Season 2009

Explanation of Fees:

The WVA Barracudas strives to offer a competitively priced program. Our dues structure is listed

CUDAS ................................................................................$45/month

AG Barracudas...................................................................$55/month

Pre-Senior Barracudas ......................................................$65/month

Senior Barracudas .............................................................$75/month

We offer three ways to pay:

               • A one time payment for the Spring/Summer
               • Monthly Billing online only at
All billing questions should be directed to Vic and Renee Riggs
Families with more than one child on the team will pay a discounted rate for 2nd, 3rd, 4th children.
There is a $50.00 Initiation Fee due upon joining the team and an annual USA Swimming registration
fee of $63.00 per swimmer. ** For New Members Only**

Fundraising Commitment:
WVA Barracudas is a non-profit organization that can not run on member dues alone. Each Family will
be asked to support these fundraising events in order to keep our dues as low as possible. We will hold
two annual fundraising efforts. The "CUDA-Thon" will be held each year (date for 2008/2009 TBA).
Cuda-thon forms will be distributed a month prior to the event so that swimmers can solicit donations
from friends, family and local businesses. We are asking each family contribute to $150/year to this
fundraising effort. We will offer prizes and incentives for our top three fundraising families. The second
form is through Meet Sponsors and Corporate Team Sponsors. Please read the information on the web-
site and ask if you have questions.

USA Registration Fee = $63.00 (valid 9/1/2008 – 12/31/2009)
Each swimmer must be registered in order to swim in practice and meets due to the insurance policy set
by USA swimming.

Family Discounts:
West Virginia Aquatics will be offering family discounts for our families with 2 or more children in our
program. Our discounts are as follows:

1st Child “Highest Rank”: No Discount
2nd Child: $10/ month off
3rd Child: $20/month off
4th Child ½ off

                         Days                             Time

„CUDAS                   Monday – Thursday                5:00 – 6:00 p.m.( Natatorium)

                         Monday- Thursday                 10:00-11:00am (Krepps)

AG Barracudas            Monday – Friday                  5:00 – 6:30 p.m. ( Natatorium)

                         Monday-Friday                    9:30-11:00am (Krepps)

PS Barracudas            Monday – Friday                  5:00 - 7:00 p.m. ( Natatorium)

                         Monday-Friday                    9:15 -11:00am (Krepps)

SR Barracudas            Monday – Friday                  3:00-5:00pm ( Natatorium)
                         Monday-Friday                    7:30-9:30am (Krepps)

Summer League Team M-W-F                                  10:00-11:00am (Krepps)

                         M-W-F                            5:00-6:00pm (Natatorium)

Workout schedule is subject to change due to conflicting activities at the WVU Natatorium. In many
cases we have advance warning and will notify you through e-mail, the newsletter, bulletin board, and
word-of-mouth. In the case of a last minute change, we will use the e-mail system to notify team
members. Please make sure we are aware of any phone number or e-mail changes so that we can update
our information.

                                          WVA Barracudas
                                    Tel. (304) 293-2289 ext. 5587

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