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High School Enrollment Form

Athlete Personal Information
Best way for PCR to contact you?
Grade
Can you swim 25 yards (one length of the pool) without stopping or touching the bottom? (If not PCR, offers swim lessons)
Do you have a transportation pass for school?
Parent/Guardian Information
Are you the emergency contact?
Confidential Demographic Information
Yes No
Parent/Guardian Education Level (check all that apply):
Athlete Medical History
Does your child have any medical conditions? (i.e. diabetes, asthma, seizure disorder, etc.)?
Does your child take any medications?
Does your child have any allergies?
Has your child suffered any injuries in the last 18 months?
Will any medical condition, medication, allergy, or injury affect your child while he/she is rowing, running, or swimming?
Does your family have any history of heart problems at a young age?
Is there anything else PCR should know about your child's health?
Does your family have medical insurance?
Photo Release and Liability Waiver

Report Card and Attendance Record Release: In order to help our participants excel in school and prepare for college, we ask that our Academic Director have access to your child's academic and attendance records. Such information is will be used to determine the amount of extra support we can provide to your child (SAT prep, subject tutoring, etc.) as part of our program, and will not affect boatings, etc. I give PCR my permission to request and review my child's report cards or other records of grades, and to his or her attendance records. Such permission applies to all such information for the current school year and for the school year immediately preceding the current school year.

I agree to the above

Photo Release: I give PCR my permission to use my child's photo in materials that promote PCR. This may include brochures, newsletters, the Internet, or other electronic media, magazines, or television.

I agree to the above

Liability Waiver and Permission: In consideration of PCR permitting my child to participate in PCR's activities and program, I, on behalf of myself and my child, hereby release, discharge, and agree to indemnify and hold harmless the City of Philadelphia (the "City"), PCR, and both the City's and PCR's officers, directors, employees, subcontractors, volunteers, and agents from any and all claims, liabilities, or causes of action arising out of (1) the student's participation in PCR's activities and programs, or (2) the student's use of PCR's rowing facility, equipment, or other premises where practices and competitions take place. 

I hereby give my child permission to participate in any and all programs associated with PCR, including but not limited to, PCR's rowing and educational programs and field trips related thereto. I understand that PCR activities may include one or more of the following: rowing on the Schuylkill River; indoor training at venues to be specified; competing in regattas in and our of Pennsylvania; swim test and swim lessons; and other such activities, including tutoring and mentoring, as they related to the goals of PCR. It is anticipated that PCR will regularly utilize vans and/or cars to transport participants to practices, races, field trips, and other events. I hereby give my permission for my child to be transported either (i) with the entire team to these events in the vans and/or cars used by PCR for transportation to these events or (ii) in the event that vans and/or cars do not have capacity to transport all rowers, coaches, and other PCR officials and volunteers, in a bus or with on of PCR's employees, coaches, officials or other volunteers in a private automobile. 

I further give my permission to PCR to give consent on my behalf in the event of the need for emergency administration of medical treatment which PCR, in its sole discretion, believes to be necessary and appropriate, including, without limitation, treatment by training First Aid personnel, EMTs, First Responders, Paramedics and Emergency Room Physicians. In consideration of PCR permitting my child to participate in PCR's activities and programs, I, on behalf of myself and my child, hereby release, discharge, and agree to indemnify and hold harmless the city, PCR, and both the City's and PCR's officers, directors, employees, subcontractors, volunteers and agents from any and all claims, liabilities or causes of action arising out of such treatment and with respect to the exercise of it and their judgement in this regard. I further attest that I have disclosed all vital and important health information (allergies, medications, and medical limitations on activities) which would be necessary for the proper care of my child. I agree to pay and to assume responsibility for all medical expenses incurred in the treatment of my chid. 

I agree to the above
Sign above