Online Registration

Family Information

Parents Name *

Mailing Address *

City *

State *

ZIP Code *

Primary Email *

Parent 1 Home Phone

Parent 1 Work Phone

Parent 1 Cell Phone

Parent 2 Home Phone

Parent 2 Work Phone

Parent 2 Cell Phone

Additional E-Mail

School District

Emergency Contact Information

Swimmer Information

Swimmer 1

Name (First, Middle, Last)

Birth Date *

Gender *

Winter Team/Level

T Shirt Size *

Swimmer 2

Name (First, Middle, Last)

Birth Date

Gender

Winter Team/Level

T Shirt Size

Swimmer 3

Name (First, Middle, Last)

Birth Date

Gender

Winter Team/Level

T Shirt Size

Parent Volunteer Information

Volunteer Information

Hampden Aquatic Club appreciates the efforts of our parents who provide the much needed support to the club, as it affords an opportunity to meet and chat with other parents while demonstrating your child(ren) that you are involved and active in their swim club. Currently, we do not make “volunteering” a mandatory requirement but we ask that you help us keep it that way by signing up to volunteering at our events. Without the help of our wonderful parents, our team cannot be where we are today!

Acknowledge Volunteering

We as a family acknowledge and agree to help the team by signing up to donate items for the concession stand and/or assist the team at events.

Team Photograph

Photographs are sometimes taken of team activities for publicity and promotional purposes and children\’s names or information are never used without specific permission. With your consent, you are releasing Hampden Aquatic Club to use photographs of your child(ren) as stated.

Photography *

Yes

I, the parent or guardian of the applicant, hereby give my permission for my child(ren) to participate in the Hampden Aquatic Club and Capital Area Swim League (CASL) during the season. I certify that the child(ren) is in good health and physically able to participate. I absolve, indemnify and hold harmless the Hampden Aquatic Club, HAC board, the coaches and CASL. I realize that I may be required to use my personal insurance coverage or be otherwise responsible for any expenses resulting from injury. I will furnish, if requested, a certified birth certificate for my child.

TEAM REGISTRATION FEES AND TERMS

All swimmers MUST be members of Hampden Township pool and pool registration fees are to be paid separately to the township. Check our website for swimmer only pool membership rates. Swimmers will not be able to participate without pool membership and registration payment satisfied. HAC registration fees are not refundable after May 31st (prior to May 31st, refunds are subject to a $25 administrative fee).

Hampden Pool Membership *

We agree to have a Hampden Pool membership for each swimmer

Agreed By: *

Enter Name

Payment Type *