Please complete our online

Medical Form

Synchro Lessons for All

Medical Release

Swimmer's First Name *

First

Swimmer's Last Name

Last

Phone *

Email *

BC Medical #

Doctors Name *

Phone *

Medical Conditions

If none, please put N/A or equivalent. Thank you!

Medications

If none, please put N/A or equivalent. Thank you!

Allergies

If none, please put N/A or equivalent. Thank you!

Other information that the club and coaches should know

If none, please put N/A or equivalent. Thank you!

Emergency Contact Info

First Name *

First

Last Name

Last

Home Phone *

Work/Cell Phone *

Relationship *

Confirmation *

By signing this document, the participant named on this medical form and his/her parents or guardians agree that the Ravensong Waterdancers Synchronized Swimming Club and it’s staff/instructors and Board members shall not be held responsible or liable for any injury, loss or damage resulting from any cause whatsoever, negligent or otherwise, while in attendance at synchronized swimming practices, functions or meets. Your contact information will be shared with BC Artistic Swimming in accordance with their membership requirements.

Your Name

First Name

Last Name

Signature *