Participant Info
- Rower's Information
- Rower's First Name
- Santiago
- Rower's Last Name
- Casillas
- Preferred Name
- Santi
- Rower's Full Mailing Address
- 68 Summerlyn way SE Gurly, AL 35748
- Rower's Phone
- 2566799742
- Account Email
- williams.ivon AT gmail.com
- Select Rowing Group
- High School/Competitive
- USRowing Membership Number
- 11557001
- USRowing Membership Expiration Date
- August 19, 2022
- USRowing SafeSport
- My rower is under 18 years of age
- Rower's Birthday
- 07/09/2004
- Rower's Age
- 17
- Rower's Current School
- Huntsville High School
- Rower's Current Grade Level
- 12th
- Rower's Gender
- Male
- Rower's Height
- 5'10"
- Rower's Weight
- 170
- Rower's Photo
Personal Info
- Parent/Guardian(s) & Emergency Contact's Information
- Parent/Guardian's Name
- Ivon Williams
- Parent/Guardian's Phone
- 2566799742
- Parent/Guardian's Email
- williams.ivon AT gmail.com
- Parent/Guardian 2 Name
- Cesar G Casillas
- Parent/Guardian 2 Phone
- Parent/Guardian 2 Email
- cesar.casillas AT gmail.com
- Who should be contacted in case of an emergency?
- Parent/Guardian 1
- Emergency Contact Name
- Glenndale Williams
- Emergency Contact Phone
- 8086792717
- Rower's Medical & Safety Information
- Select Medical Conditions
- None of the issues listed here
- If a medical condition was selected, please explain here.
- List known Allergies
- n/a
- List any other known Medical Conditions
- n/a
- Rower is Physically Able to Row
- Yes
- Primary Care Physician's Name Name
- Dr Joel Edwall
- Primary Care Physician's Number
- 256 551 5400
- Medical Insurance Provider
- Tricare
- Medical Insurance Contract/ID #
- 1275736402
- Medical Insurance Policy/Group #
- NA
- Can rower tread water for 10 minutes?
- Yes
- Rower has completed an RCRC Swim Test
- Yes
- When will I Upload the Physical
- Rower has completed physical and will or has uploaded the form
- RCRC WAIVERS
- RCRC Waivers: Please read and check the boxes to agree to the following waivers below: Participation Waiver, Liability Relating to Coronavirus/COVID-19 Waiver, Carpool Release, & Youth Media Release.
- Participation Waiver
- Yes
- Waiver of Liability COVID-19
- Yes
- Carpool Release Agreement
- Yes
- Youth Media Release Agreement
- Yes
- Payment Options
- Credit Card
- Rower's T-Shirt Size
- M
- Where did you hear about RCRC's Rowing Program?
- RCRC Website
- Signature
- Ivon Williams
- Oct. 16 & 17 Regatta
- Both Days
- Nov 13 Regatta
- **WHAT TO DO IF YOU SELECT THE WRONG IMAGE/FILE WHEN UPLOADING**
- Once you select an image/file to upload, you have to save it before you can change it. Ex. You select an image of the physical's 2nd page where the 1st page should be: click save - delete it - and attach it in the right place.
- Provide the date the physical was performed (on the physical) & Upload both pages of your physical as either: Two images - one of each page (jpeg preferred) or One document (pdf preferred) with both pages.
- Date Physical Was Performed
- August 23, 0021
- IMAGE - upload Physical Form Page 1 of 2
- IMAGE - upload Physical Form Page 2 of 2
- FILE - upload Physical Form
- santiagos_physical.pdf
- Upload the signed page of the Youth Conduct as either an image or file & Upload the COVID-19 Rules of Conduct Contract as either: Two images - one of each page or One document with both pages. (jpeg & pdf preferred)
- IMAGE - upload Youth Conduct Code Page 1 of 1
- FILE - upload Youth Conduct Code
- santiagos_rcr_conduct_code_.pdf
- IMAGE - upload COVID-19 Rules of Conduct Contract Page 1 of 2
- IMAGE - upload COVID-19 Rules of Conduct Contract Page 2 of 2
- FILE - upload COVID-19 Rules of Conduct Contract
- santiagos_rcrc_covid-19_rules.pdf
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- Help RCRC Out: After you upload a form, check the corresponding box below. This will help us keep track that each rower has uploaded all the documents needed to finish the registration process. Thanks!
- I have completed my forms!
- Physical, Youth Conduct Code, COVID-19 Waiver