Welcome to Vancouver Pacific Wave Synchronized Swim Club's
Online Registration Page

Swimmer Information:

Last Name First Name

Street Address Apt

City Province Postal Code Phone( ) -

Birth Year Birth Month 01 02 03 04 05 06 07 08 09 10 11 12 Birth Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Household Email InvalideInvalid

Fax Work

Mother's Name Mother's Cell

Father's Name Father's Cell

Swimmer's Cell Swimmer's Email A value is required.Invalid format.

Emergency Contact Name Emergency Contact Phone

Program Selection:

I am registering my child/ward for the following course(s):
(To make multiple selections, hold the ctrl button as you select)

Spring Watermania StarPlus Spring Hillcrest StarPlus Spring Byng StarPlus Winskill Synchro for Beginners

Pricing and Payment:

We accept cheques or PayPal. Price: Watermania, Hillcrest and Byng programs: $250/12 week session. Winskill program: $200/12 week session.

I will pay using PayPal in the Next Step, after I complete and submit this form.

I have mailed a cheque payable to VPW. Mailing address: Suite 642, 3495 Cambie St, Vancouver BC V5Z 4R3

Swimmer Care Card and Doctor:

BC Care Card Number: Family Doctor Doctor Phone

Photo Release

In the course of this activity, pictures may be taken and recordings may be made.  Please advise us if you are willing to have your child’s/ward photograph or voice used for the promotion of Synchro, as indicated below:

I, on behalf and on behalf of my child/ward, give permission to Vancouver Pacific Wave to photograph and/or record my child/ward and or my child’s/ward’s voice on still photographs, motion picture film, audio tape and/or video tape and to use this material in whole or in part, through the media of television, film, Internet, multi-media presentation, radio. Audiotape, videotape or in printed form or displayed form for the promotion of Synchronized Swimming.  I, on behalf and on behalf on my child/ward assign and transfer to Vancouver Pacific Wave any and all rights, including copyright, which I may have or my child/ward may have in this material.

I give my permission as set out above.
I do not give permission.

Parent/Guardian Agreement and Waiver

I am the swimmer’s parent or legal guardian.  I certify to Vancouver Pacific Wave (the “CLUB”) that all of the information provided above is true and complete and, if this application is accepted by the CLUB:

• I PROMISE TO OBSERVE the rules and regulations of the club and cause the swimmer to do the same.

• I HEREBY GIVE PERMISSION AND AUTHORIZATION to Vancouver Pacific Wave, its administrators, coaches and/or designated chaperon(s) to provide general supervision and authorization for any medical treatment they deem necessary and/or reasonable while the swimmer is competing at any swim meet.

• AND THE SWIMMER HEREBY RELEASE THE CLUB from any claim that I or the swimmer may have, against the club, as a result of any injury (including death) to myself or the swimmer, or the loss or damage to our property whether or not caused by the negligence of the club.

I Accept I Decline
Name