North Chevy Chase Swimming Pool Association

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 Phone
Address*
Street Address Address Line 2 City State ZIP Code
First Child's Name*
First Last
Enter the name of the first diver you would like to register
First Child's Birth Date*
Date Format: MM slash DD slash YYYY

Enter the birth date of the first diver you would like to register
First 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 register
Second Child's Birth Date
Date Format: MM slash DD slash YYYY

Enter the birth date of the second diver you would like to register
Second Child's age on June 1st of THIS year
Third Child's Name
First Last
Enter the name of the third diver you would like to register
Third Child's Birth Date
Date Format: MM slash DD slash YYYY

Enter the birth date of the third diver you would like to register
Third Child's age on June 1st of THIS year
Authorization/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