RICHMOND RACERS SWIM TEAM
2009-2010 REGISTRATION FORM
REGISTRATION FEES: (2009-2010 Fees)
City Residents *
Non-City Residents
(includes $20.00
Surcharge)
*Please note that a city resident is a person who lives within the City of Richmond (per the US Postal Service zip code). The
significant zip codes for the City of Richmond are 23219 through 23235; however, some of these overlap into the surrounding
counties. A determination will be made on a case by case basis.
A city resident must be able to demonstrate proof of residency, subject to verification using
any one of the following documents: 1. Real Estate Tax Statement; 2. Virginia Drivers License (with city address
subject to zip code verification); 3. Utility Bill with name and address; or 4. Voter Registration Card.
Swimmer's Full Name:
Birthday:
Age:
Nickname:
Email:
T-Shirt Size:
Home
Phone:
Work
Phone:
Summer Swim Team:
Father/Guardian Name:
Mother/Guardian Name:
Emergency
Contact:
Phone Number:
M
F
Last First Middle Suffix
Level 1st Child 2nd Child 3rd Child 4th Child 5th Child
Pre-Team
Group I & II
Group III & IV
Group Varsity
Group V
Level 1st Child 2nd Child 3rd Child 4th Child 5th Child
Pre-Team
Group I & II
Group III & IV
Group Varsity
Group V
$445
$495
$495
$530
$455
$210
$505
$540
$515
$505
$550
$485
$535
$535
$240
$570
$475
$525
$525
$560
$465
$230
$515
$250
$220
$235
$260
$260
$310
$245
$270
$320
$280
$270
$330
$275
$300
$300
$190
$350
$265
$290
$290
$340
$255
$180
$280
$200
$160$170
School:
Grade:
Waiver: I authorize the City of Richmond Department of Parks, Recreation and Community
Facilities, Special Services Aquatics Branch staff to act according to their best judgment in an emergency requiring medical attention. I
hereby waive and release the city and/or it’s designates from any and all liability and costs associated with the Richmond Racers Swim
Team. I further understand that my medical insurance carrier or I will be responsible for any expense arising from said emergency. I
consent to travel for my child to and from designated swim meets.
Signature of Parent/Guardian
Address:
City:
Zipcode:
Cell Phone:
Please Complete One Form Per Swimmer
Cell
Phone:
Email:
Cell
Phone:
Work
Phone:
Home
Phone:
