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Divers' Full Name
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Divers' Date of Birth
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Gender
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Third Choice
Divers' Address- include zip code
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Parent or Guardian Name
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Email
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Phone Number
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Parent or Guardian Name
Email
Phone Number
Medical conditions, medication, allergies, learning issues
Team Fall Program
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Junior Olympic
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Future Champions Red
Future Champions Black- 3 days/week
Future Champions black- 2 days/week
Future Champions White
Learn To Dive
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January
February
Medical Release- In the event that an injury occurs to my child while on the pool premises and I am unable to be reached, I hereby give my permission for a representative of San Antonio Divers to seek medical treatment. I also authorize any and all emergency medical and hospital care and treatment deemed necessary by a duly licensed physician at any medical facility for the health and well-being of my child. I assume all responsibility for payment of any and all medical expenses involved in my childs treatment.
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By checking the box I agree to the above statement.
Permission for San Antonio Divers to use your child's photograph or video image for advertisement, website or promotion, and/or acknowledge their personal performance.
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