Dive Team Registration Please fill out the entire form and sign the authorization/waiver. Sections marked with an * are required. Parent 1 Name* First Last Parent 1 Email* Parent 1 Phone*Parent 2 Name First Last Parent 2 Email Parent 2 PhoneAddress* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code First Child's Name* First Last Enter the name of the first diver you would like to registerFirst Child's Birth Date* Date Format: MM slash DD slash YYYY Enter the birth date of the first diver you would like to registerFirst Child's age on June 1st of THIS year*Second Child's Name First Last Enter the name of the second diver you would like to registerSecond Child's Birth Date Date Format: MM slash DD slash YYYY Enter the birth date of the second diver you would like to registerSecond Child's age on June 1st of THIS yearThird Child's Name First Last Enter the name of the third diver you would like to registerThird Child's Birth Date Date Format: MM slash DD slash YYYY Enter the birth date of the third diver you would like to registerThird Child's age on June 1st of THIS yearAuthorization/Waiver:* By checking here and signing below, I hereby authorize my child(red) to participate in all activities of North Chevy Chase Swimming Pool Association (NCCSPA) Inc. Dive Team during this year’s summer dive season, including practices, competitions, award ceremonies and social events, wherever held, and including transportation of any kind provided in connection with such activities. I also accept full responsibility for my child(ren)’s welfare, and intend to legally bind myself, my spouse, child(ren), heirs, executors, administrators and assigns. I do hereby release and forever discharge the NCCSPA, its officers, directors, employees, agents, coaches and members, including but not limited to NCCSPA members conducting, chaperoning, or providing transportation or support for such activities, and for any and all damages which may be sustained by me or my child(ren) in connection with participation in such activities and knowingly assume all risks in connection therewith. Authorization Signature*Signature Date* Date Format: MM slash DD slash YYYY