Registration - San Antonio Divers

Divers Name *

First

Middle

Last

Address *

Zip Code *

Date of Birth *

Gender *

Grade 2026/2027 Year *

Parent/Guardian Name *

First

Last

Parent Email *

Program Type *

Training Group *

Practice Days

Monday
Tuesday
Wednesday
Thursday

Parent/Guardian Address (if different from diver's)

Phone Number *

different Parent/Guardian diver's)

Parent/Guardian Name

Phone Number

Medical Conditions, Medication, Allergies, Learning Issues

Medical release *

I agree

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 child’s treatment. * • • By checking the box, I agree to the above statement.

Photographs and video relaese *

I agree to allow my child to be photograped
I do not want my child photographed

Permission for San Antonio Divers to use your child's photograph or video image for advertise-ment, website or promotion, and/or acknowledge their personal performance. *