Rower's First Name* Rower's Last Name* Preferred Name Rower's Full Mailing Address* Street, City, State, Zip Rower's Phone* This will not be disseminated through the team, and will only be used by coaches, team captains, and team coordinators - if necessary. Account Email* This email address will be the assigned to the rower's registration account. Select Rowing Group* USRowing Membership Number* Note: After verifying your rower's USRowing Membership is still up to date, please enter the membership number here. If your rower does not have a USRowing number, or his/her membership has expired, please register or reregister your rower with USRowing. Visit https://membership.usrowing.org and select the Individual BASIC Membership ($9.75). You will need RCRC's club code which is X33UY, and it is case sensitive. If your rower is already a member, but you don't remember your rower's number, follow the USRowing link above to recover the number. Membership provides insurance coverage for your rower and is required for registration. USRowing Membership Expiration Date* Required format - ex. 08/21/2021 USRowing SafeSport* Note: If Rower is 18 years or older, he/she will have to complete a USRowing SafeSport course online. The USRowing SafeSport program addresses six areas of misconduct: sexual misconduct (including child sexual abuse and/or grooming behaviors), emotional misconduct, physical misconduct, bullying, hazing, and harassment. Rower's Birthday* Required format - ex. 08/21/2021 Rower's Age* Rower's Current School* Rower's Current Grade Level* ex. 9th, 10th Rower's Gender* Female Male Rower's Height* A guestimate is fine. ex. 5'2" Rower's Weight* A guestimate is fine. Parent/Guardian's Name* Please enter the name of one parent/guardian that is to be the MAIN POINT OF CONTACT concerning rower's participation with the team. Parent/Guardian's Phone* Please enter the cell phone number of the parent/guardian that is to be the MAIN POINT OF CONTACT concerning rower's participation with the team. Parent/Guardian's Email* Please enter the email of the parent/guardian that is to be the MAIN POINT OF CONTACT concerning rower's participation with the team. Parent/Guardian 2 Name (optional) Parent/Guardian 2 Phone (optional) Parent/Guardian 2 Email (optional) Who should be contacted in case of an emergency?* Emergency Contact Name Please name another person who can be contacted in the event of an emergency (i.e. a trusted friend or family member, etc.) who could be called if the above parent(s)/guardian(s) are not available. Emergency Contact Phone Phone Number of above named Trusted Friend/Family/Additional Emergency Contact Select Medical Conditions* Select all medical conditions that apply to the Rower. If a medical condition was selected, please explain here. List known Allergies* List other known allergies, if any, to food, medications, etc. (if none, please enter "N/A".) List any other known Medical Conditions* List any other known medical conditions of which Rocket City Rowing Club may need to be aware (if none, enter "N/A"). Rower is Physically Able to Row* Rower is physically able to participate in all RCRC rowing and training activities. Primary Care Physician's Name Name* Primary Care Physician's Number* Medical Insurance Provider* Medical Insurance Contract/ID #* Medical Insurance Policy/Group #* Permission to Provide Emergency Care* Rocket City Rowing Club has permission to initiate emergency care for the above named child. Can rower tread water for 10 minutes?* Yes No Rower has completed an RCRC Swim Test* Note: Select yes if you have taken the RCRC swim test before. This test only needs to be taken once. It examines treading in water for 10 minutes and able to put life vest on while in water. When will I Upload the Physical* Note: The physical form needs to be completed by a parent/guardian and physician or nurse practitioner and returned to RCRC within 4 weeks of registration. Many walk-in clinics offer this service for a low fee. (Must have been completed by physician/CRNP in the last 12 months,) Participation Waiver* I agree to RCRC Participation Waiver
ROWING RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT
PARENTAL CONSENT REQUIRED FOR ALL MINOR PARTICIPANTS (Less than 19 years of age)
IN CONSIDERATION of being given the opportunity to participate in any way in the Rocket City Rowing Club, Inc. (hereafter "Club")
activities ("Activity") until the term of which my dues have been paid, I, for myself, my personal representatives, assigns, heirs, and
next of kin:
1. ACKNOWLEDGE, agree, and represent that I understand the nature of Rowing Activities, both on water and land based, and that I
am qualified, in good health, and in proper physical condition to participate in such Activity; I further acknowledge that any questions I
have concerning the Activity of the Club and its members has been fully explained to my satisfaction;
2. FULLY UNDERSTAND that: (a) ROWING ACTIVITIES INVOLVE RISKS AND DANGERS of serious bodily injury, including
permanent disability, paralysis, and death ("Risks"); (b) these Risks and dangers may be caused by my own actions, or inactions, the
actions or inactions of others participating in the Activity, the condition in which the Activity takes place, or the negligence of the
Releasees names below; (c) there may be other risks and social and economic losses either not known to me or not readily
foreseeable at this time; and I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES,
COSTS, AND DAMAGES I incur as a result of my participation in the Activity;
3. AGREE AND WARRANT that I will examine and inspect each Activity in which I take part as a member of the Club and that, if I
observe any condition which I consider to be unacceptably hazardous or dangerous, I will notify the proper authority in charge of the
Activity and will refuse to take part in the Activity until the condition has been corrected to my satisfaction;
4. HEREBY RELEASE, discharge, and covenant not to sue the Club, their administrators, directors, officers, volunteers, and other
participants (each considered one of the Releasees herein) from all liability, claims, demands, losses, or damages on my account
caused or alleged to be caused in whole or in part by the Releasees or, any other person or entity, or otherwise, including negligent
rescue operations; and I further agree that if, despite this release and waiver of liability, assumption of risk, and indemnity agreement,
I, or anyone on my behalf, makes a claim against the Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS each of the
Releasees from any litigation expenses, attorney fees, loss, liability, damage, or cost which any may incur as the result of such claim.
I have read this agreement, fully understand its terms, understand that I have given up substantial rights by signing it and have signed
it freely and without any inducement or assurance of any nature other than contained herein and intend it to be a complete and
unconditional release of all liability to the greatest extent allowed by law and agree that if any portion of this agreement is held to be
invalid the balance, notwithstanding, shall continue in full force and effect.
AND
I, the minor's parent and/or legal guardian, understand the nature of rowing activities and the minor's experience and capabilities and
believe the minor to be qualified to participate in such activity. I hereby release, discharge, covenant not to sue, and AGREE TO
INDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees from all liability claims, demands, losses, or damages on the
minor's account caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise, including
negligent rescue operations, and further agree that if, despite this release, I, the minor, or anyone on the minor's behalf makes a claim
against any of the above Releasees, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS, each of the Releasees from any litigation
expenses, attorney fees, loss liability, damage, or cost any may incur as the result of any such claim. Waiver of Liability COVID-19* I agree to RCRC Waiver of Liability Relating to
Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World
Health Organization. COVID-19 is reported to be extremely contagious. The state of medical
knowledge is evolving, but the virus is believed to spread from person-to-person contact
and/or by contact with contaminated surfaces and objects, and/or by contact with aerosolized
droplets. People reportedly can be infected and show no symptoms and therefore spread the
disease. The exact methods of spread and contraction are unknown, and there is no single
treatment, cure, or guaranteed outcome following a COVID exposure and/or infection.
Evidence has shown that COVID-19 can cause serious and potentially life threatening illness
and even death.
The Rocket City Rowing Club (RCRC) cannot prevent you for your child(ren)] from becoming
exposed to, contracting, or spreading COVID-19 while utilizing RCRC's services or premises.
It is not possible to prevent against the presence of the disease. Therefore, if you choose to
utilize RCRC's services and/or enter onto RCRC's premises you may be exposing yourself to
and/or increasing your risk of contracting or spreading COVID-19.
ASSUMPTION OF RISK: I have read and understood the above warning concerning
COVID-19. I hereby choose to accept the risk of contracting and possibly spreading
COVID-19 for myself and/or my children in order to utilize RCRC's services and enter the
RCRC's premises. These services are of such value to me (and/or to my children] that I
accept the risk of being exposed to, contracting, and/or spreading COVID-19 in order to
utilize RCRC's services and premises in person.
WAIVER OF LAWSUIT/LIABILITY: I hereby forever release and waive my right to bring suit
against RCRC and its owners, officers, directors, managers, officials, trustees, agents,
employees, or other representatives in connection with exposure, infection, and/or spread of
COVID-19 related to utilizing RCRC's services and premises. I understand that this waiver
means I give up my right to bring any claims including for personal injuries, death, disease or
property losses, or any other loss, including but not limited to claims of negligence and give
up any claim I may have to seek damages, whether known or unknown, foreseen or
unforeseen.
CHOICE OF LAW: I understand and agree that the law of the State of Alabama will apply to
this contract.
COVID Liability Release - Pg 1 of 2
I HAVE CAREFULLY READ AND FULLY UNDERSTAND ALL PROVISIONS OF THIS
RELEASE, AND FREELY AND KNOWINGLY ASSUME THE RISK AND WAIVE MY RIGHTS
CONCERNING LIABILITY AS DESCRIBED ABOVE. Carpool Release Agreement* I agree to the RCRC CARPOOL RELEASE: Assumption of Risk, Waiver of Claims and Indemnity Agreement: RCRC’s provides a method whereby individuals interested in carpooling may voluntarily do so. Parents are welcome to travel with the team. Parents who agree to chaperone must adhere to the team method of travel and the team schedule. Users of the carpool are advised that its use is voluntary and entirely at their and their parent’s/guardian’s discretion. If parents/guardians do not wish to utilize the carpool, it is their responsibility to get themselves and their rower to and from regattas. Rowers are not permitted to transport themselves or other rowers to regattas. No background checks of drivers or participants, driver record checks or insurance checks are undertaken by RCRC. RCRC does not make any assurances or certifications regarding the condition, suitability or safety of the vehicles being used by participants, the reliability or driving ability of participants or drivers, or whether those participants and drivers are insured. Responsibility for Insurance. It is the responsibility of individuals participating in a carpool to notify their insurance provider of their intent to carry non-family passengers and to ensure that they have adequate coverage to protect both themselves and their passengers. It is the responsibility of the driver of the vehicle to ensure they have an acceptable driving record, are licensed accordingly and have adequate insurance to protect both themselves and passengers. RCRC is in no way responsible for verifying or certifying the reliability, driving ability or insurance status of drivers and participants. Waiver of Claims & Indemnification RCRC takes no responsibility for any personal injuries, deaths, property damages, financial losses or other damages or losses that may result from the use of carpooling. By participating in the RCRC’s carpool program, you hereby agree to waive any and all claims that you have or may have in the future against RCRC and to release them from any and all liability for loss, damage, expense or injury including death that you, your next of kin or a third party may suffer as a result of your participation in or involvement in the RCRC program. You hereby also agree to indemnify and hold harmless RCRC from any and all liability for personal injury, death, property damages and any other loss, and resulting claims or actions, arising from your participation in or involvement in the RCRC program. I have read and understand the DESCRIPTION OF SERVICE, ASSUMPTION OF RISK AND WAIVER OF CLAIMS AND INDEMNITY AGREEMENT Youth Media Release Agreement* I agree to RCRC Youth Media Release. As the parent and/or guardian of the participant, I hereby grant Rocket City Rowing Crew, hereafter referred to as RCRC, permission to use, reproduce, and/or publish photographs and/or video that may pertain to my junior rower—including his/her image, likeness and/or voice without compensation. I understand that this material may be used in various publications, public affairs releases, recruitment materials, broadcast public service advertising (PSAs), or for other related endeavors. This material may also appear on RCRC's Internet Web Page. This authorization is continuous and may only be withdrawn by my specific rescission of this authorization. Consequently, RCRC may publish materials, use my child’s name, photograph, and/or make reference to him/her in any manner that the RCRC or project sponsor deems appropriate in order to promote/publicize rowing events. Payment Options* PayPal Credit Card Check made out to Rocket City Rowing Crew to be brought to RCRC Cash Other Note: Payment is expected immediately after registration. (Please contact RCRC Youth Coordinator if alternative payment arrangements need to be made). Please choose from one of the options. Rower's T-Shirt Size* XS S M L XL XXL Adult Sizes Where did you hear about RCRC's Rowing Program?* Signature* By signing, you attest that you have answered each question honestly and accurately to the best of your knowledge. In place of your signature, please type your full name here. 