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Summer 2018

Parent/Guardian Information

At least one parent/guardian registration is required.
New accounts will be sent an email confirmation message with instructions to setup a password.

Please indicate which parents will be volunteering this season. At least one parent/guardian is required to volunteer.

At least one parent/guardian email address must be provided.
Check the boxes to indicate which parent/guardians should receive team-wide emails.

First Name * Last Name * Email Address *
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Primary Phone Volunteer?

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Athlete Information

Enter the information for each athlete being registered below. At least one Athlete registration is required.

First Name * Preferred Name Middle Initial Last Name * Gender * Birth Date *
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Home Address

Brookfield Swim Club Member Number

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Team Shirt

Please provide shirt size for each swimmer. Sizes available in YS, YM, YL, AS, AM, AL, AXL, A2XL. Register by April 10th to guarantee shirt size. Parents can order extra shirts for $10/shirt. Please email brookfieldbreakers@gmail.com for details. Thank you! *

NVSL Participation Waiver

The following waiver MUST be signed by all athletes’ guardian(s) in order to participate in any swim practice or meet covered by NVSL insurance. Incorporate a version of this waiver into your registration process. Any or all waivers shall be available to be forwarded to the NVSL Board if requested.

NO WAIVER = NO PARTICIPATION = NO EXCEPTIONS


As Parent/Guardian of the above-name minor(s), I grant permission for the swimmer(s) to
participate in all activities of the Brookfield Breakers Swim Team, a Northern Virginia Swimming League
(NVSL) member team. I represent and warrant that my minor child/children participating on the
Brookfield Breakers Swim Team are in good health and have no physical condition, ailment or disability
which renders them unable to participate in vigorous physical activity. For and in consideration
of benefits derived from participation in the Brookfield Breakers Swim Team program, I understand that the
risk of injury to my child from the activities involved in these programs is significant, including
the potential for permanent disability and death, and while particular rules, equipment, and
personal discipline may reduce this risk, the risk of serious injury does exist. I assume all risks
and hazards arising out of, or related to, such participation, including, but not limited to,
transportation to and from such activities, and do hereby indemnify, release and hold harmless
the Brookfield Breakers Swim Team, its coaches, team representatives, volunteers, property manager,
employees and agents, as well as the Northern Virginia Swimming League, from all claims of any
kind whatsoever which may arise or hereafter accrue in connection with my child’s/children’s
participation in activities of the Brookfield Breakers Swim Team. I further grant permission for first aid to
be given to my child/children in an emergency, and will be solely responsible for any medical
costs which may arise. I AGREE THAT THEY WILL ABIDE BY THE NORTHERN VIRGINIA SWIMMING
LEAGUE CODE OF CONDUCT.

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Enter your initials to indicate acceptance: *