Registration Payment Form Swimmer Name First Last Swimmer Date Of Birth Date Format: DD slash MM slash YYYY Swim ClubParent InformationParent Name First Last Parent Email Parent Cell PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Sibling Click here if you would like to enroll a sibling.Sibling First Name, Last Name First Last Birth Date: Sibling Date Format: DD slash MM slash YYYY Product NameSelect number of weeks : 2 weeks & Up : $549 / wk 4 weeks & Up : $509 / wk 6 weeks & Up : $499 / wk Number of Weeks23456789Product NameSelect number of weeks : HALF DAY - SIBLING 2 weeks & Up : $549 / wk 4 weeks & Up : $509 / wk 6 weeks & Up : $499 / wk Number of Weeks - SIBLING23456789PLEASE SELECT YOUR WEEKS: July 1 - July 5 July 8 - July 12 July 15 - July 19 July 22 - July 26 July 29 - August 2 August 5 - August 9 August 12 - August 16 August 19 - August 23 PLEASE SELECT YOUR SIBLING WEEKS: July 1 - July 5 July 8 - July 12 July 15 - July 19 July 22 - July 26 July 29 - August 2 August 5 - August 9 August 12 - August 16 August 19 - August 23 PLEASE CONFIRM NUMBER OF WEEKS FIELD MATCHES DATES YesSubtotal $0.00 Coupon Please use the coupon code SIBLING to get your 5% sibling discount from the total tuition amount. Amount Due $0.00 All payments are nonrefundable.Credit Card Card Details Cardholder Name Release Of Liability Waiver Important notice re COVID-19: Please note any interaction with the general public poses an elevated risk of being exposed to COVID-19 and we cannot guarantee that you will not be exposed while in attendance at the event. The event organizer is solely responsible for the health and safety of this event. Participants still assume all the risk. NYC Swimming will be following all the guidelines set out by the New York Safety Precautions for Business and the CDC “Considerations for Public Pools, Hot Tubs, and Water Playgrounds During COVID-19.’ Additionally, we’ll be following the operating facility, this will include social distancing and limited use of the locker rooms. I, the undersigned, hereby for myself, my heirs, executors and administrators, release, discharge and absolve NYC Swimming (herein referred to as “nyc swimming”), its agents, officers, directors, and employees from any liability, loss, costs, or expenses (including attorney fees and disbursements) incurred as a result of any accident and/or injury during swimming practice, dryland or other events except to the extent that an accident and/or injury is caused by or results from the negligence or willful misconduct of NYC Swimming.Photo Release Waiver I hereby grant to NYC Swimming and to its employees, agents and assigns the right to photograph my dependent and use the photo and or other digital reproduction of him or her, or other reproduction of his or her physical likeness, for publication purposes, whether electronic, print, digital or electronic via the Internet.Date Date Format: MM slash DD slash YYYY Participant Name First Last SignatureParent / Guardian Name First Last Emergency Phone NumberAgreement I have read and understand and agree on behalf of myself and my minor child/ward to be bound by the terms of this agreement. I have explained all risks to my child and their personal responsibilities for adhering to the rules.Signature