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Swim Team Registration Form - 2018 Season

Directions: This form must be completed in full by all parents/guardians of current and prospective swim team members before your child may join the swim team and/or participate in any practices or meets.

All registered swimmers get a DH Swim t-shirt and latex swim cap. 

The preferred method of payment is credit card, which you may enter as you complete your registration.  Or if you prefer you may pay by check made payable to “DHARA Summer Swim and Dive Program”.  Please mail checks to Mike Allen, 866 N Kensington Street, Arlington VA 22205 no later than May 14.  Your registration is not complete until payment is received. 

Parent/Guardian Information

At least one parent/guardian registration is required.
New accounts will be sent an email confirmation message with instructions to setup a password.

Please indicate which parents will be volunteering this season. At least one parent/guardian is required to volunteer.

At least one parent/guardian email address must be provided.
Check the boxes to indicate which parent/guardians should receive team-wide emails.

First Name * Last Name * Email Address *
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Primary Phone Volunteer?

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Athlete Information

Enter the information for each athlete being registered below. At least one Athlete registration is required.

First Name * Preferred Name Middle Initial Last Name * Gender * Birth Date *
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Home Address

Dominion Hills Member Number

What is your Dominion Hills membership number? *

Mini Warrior

Please list any swimmer(s) that you think will be a Mini Warrior.

PERMISSION STATEMENT

I hereby give permission for my child(ren) to travel on any Dominion Hills Swim Team trip, and release the Dominion Hills Recreation Association (DHARA), its agents, the Dominion Hills Swim Team Representatives and Coaches, and any parents or other volunteers involved in such trips from liability for both injury or damage that my child(ren) may sustain during the trip.

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Enter your initials to indicate acceptance: *
Code of Conduct

NVSL® Standards of Conduct

The following Standards of Conduct shall guide swimming and diving within the Northern Virginia Swimming League (NVSL). They promote respect, fairness, civility, honesty, responsibility, and appropriate behavior.These Standards foster a positive environment at all swim and dive meets; establish an atmosphere of respect for all participants, officials, and spectators; produce positive learning outcomes for all; build participant and team spirit; and enhance the sports of swimming and diving.

All Athletes, Coaches, Team Representatives, Officials, Parents / Spectators, and NVSL Leadership shall:

Abide by the established rules of the NVSL.

Respect all officials at all times, and address them in a courteous manner.

Avoid using inappropriate language, profanity, humiliating or intimidating remarks or behavior, verbal or physical assault toward any athlete, coach, team representative, official, NVSL leadership representative, or spectator.

Follow applicable management, pool, and facility rules, respecting others’ property at all times.

Display respect, courtesy, and good manners toward athletes, coaches, Team Representatives, and spectators.  Team Representatives shall assist officials in maintaining control of spectators during meets.

Demonstrate humility in victory and courtesy in defeat.

Head Coaches shall:

Ensure athletes and assistant coaches demonstrate maturity and good sportsmanship toward other athletes, officials, coaches, and spectators at all times.

Lead by example to instill a love for the sport, advanced aquatic skills, teamwork and good sportsmanship in their team.

Spectators shall:

Maintain an appropriate distance from the competition area by remaining in established viewing areas and shall not encroach the pool deck or interfere with any officials.

Not engage in loud, intimidating, disrespectful, or negative behavior toward officials, athletes, other spectators, support personnel, or pool staff (including lifeguards).

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Enter your initials to indicate acceptance: *
NVSL Participation Waiver

As Parent/Guardian of the above-name minor(s), I grant permission for the swimmer(s) to participate in all activities of the DHARA Swim Team, a Northern Virginia Swimming League (NVSL) member team. I represent and warrant that my minor child/children participating on the DHARA Swim Team are in good health and have no physical condition, ailment or disability which renders them unable to participate in vigorous physical activity. For and in consideration of benefits derived from participation in the DHARA Swim Team program, I understand that the risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist. I assume all risks and hazards arising out of, or related to, such participation, including, but not limited to, transportation to and from such activities, and do hereby indemnify, release and hold harmless DHARA, the DHARA Swim Team, its coaches, team representatives, volunteers, property manager, employees and agents, as well as the Northern Virginia Swimming League, from all claims of any kind whatsoever which may arise or hereafter accrue in connection with my child’s/children’s participation in activities of the DHARA Swim Team. I further grant permission for first aid to be given to my child/children in an emergency, and will be solely responsible for any medical costs which may arise. I AGREE THAT THEY WILL ABIDE BY THE NORTHERN VIRGINIA SWIMMING LEAGUE CODE OF CONDUCT.

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Enter your initials to indicate acceptance: *
Photo and Video Release

To promote its Summer Water Sports programs, Dominion Hills Area Recreation Association (“DHARA”) permits the swim team and dive team to take photographs and/or videos of team members. If you consent to allow DHARA unrestricted usage of those photographs or videos of your child(ren) on its website, Swimtopia team page, social media, or any other publicly available print or digital media, please confirm your acceptance by checking the box and entering your initials where indicated below. 

I am the parent or legal guardian of the minor child(ren) (named above as "Athlete(s)") and have the authority to give consent to this release. I grant DHARA the right to use photographs or videos of me or my minor child(ren) on its website, Swimtopia team page, social media, or any other publicly available print or digital media. I understand that we will receive no financial compensation for DHARA’s use of such photographs or videos. I release DHARA and its directors, officers, employees, and volunteers from liability for any claims arising from DHARA’s use of such photographs or videos.

Enter your initials to indicate acceptance: