The Perfect IM Registration

Official Registration FORM

"*" indicates required fields

Swimmer's Full Name*

First Last

Swimmer's Age*

Please enter a number from 8 to 17.

Swimmer's Date of Birth*

Swimming Ability/level:*

This is not a beginner level clinic. You must be at least an intermediate swimmer to participate.

Intermediate

Team - Advanced

Team Code

Camp/Clinic Fee

Price:

Total

Child's Health

Allergies/Asthma:*

Please type "None" if not applicable

Medications:*

Please type "None" if not applicable

Other Known Condition:*

Please type "None" if not applicable

Parent/Guardian

Parent/Guardian's Name*

First Last

Parent/Guardian's Email*

(we do not share e-mail addresses)

Parent/Guardian's Phone*

Secondary Phone*

Parent/Guardian's Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Who else has permission to pick up your child/children?

Authorized adult #1

First Last

Authorized adult #1 Phone

Authorized adult #2

First Last

Authorized adult #2 Phone

Special instructions/Notes

Parent/Guardian Consent

Release statement:*

The undersigned parent or legal guardian of the child/children listed above hereby consents and authorizes participation in The Perfect IM Professional Swim Camp at Gian Zumpano Aquatic Center. I understand that my child/children will engage in a number of sports and activities that require physical exertion and acknowledge that there is a risk of personal injury to my child/children. In consideration for The Perfect IM Professional Swim Camp at Gian Zumpano Aquatic Center Facilities accepting the above names children into the Exclusive Swim Camp, I do hereby for myself, my spouse, my children, my heirs, personal representatives and assigns, forever discharge The Perfect IM Professional Swim Camp, Miami Swimming, Belen Jesuit Prep School, ProSport Live, Legacy Swimming, coaches, operators, it's agents, servants, associates, officers, directors, affiliates, sureties, successors, and either in law or equity, arising from or as a result of my child/children's participation in the The Perfect IM Professional Swim Camp at Gian Zumpano Aquatic Center Facilities. In addition, I hereby authorize and accept financial responsibility for The Perfect IM Professional Swim Camp and Gian Zumpano Aquatic Center Facilities staff to seek all medical attention for my child/children in the event of an emergency. I also give permission for the free use of my child's name and image in case of any broadcast, telecast, or printed media account of this activity.

I hereby grant the operators and their legal representatives and assigns (including but not limited to any agency, client, or publication), irrevocable permission to publish photographs of my child taken at The Perfect IM Professional Swim Camp at Gian Zumpano Aquatic Center Facilities.

I understand that images and footage may be published in camps marketing videos, online and print advertisement and social media related to our youth programs only. Images and footage is only use for promotional purposes and never sold for profit without parents' consent. Furthermore, I will hold harmless the aforementioned photographer/videographer and his/her legal representatives and assigns, from any liability by virtue of minor cropping that may be required, and colour and exposure shifts that may occur in reproducing this photograph.

Consent

Payment Information

Total

Credit Card

Card Details

Cardholder Name

Signature*