RCRC Rower Information

Participant Info

Rower's Information
Rower's First Name
Adi
Rower's Last Name
Gowda
Preferred Name
ADI
Rower's Full Mailing Address
1408 Toney Dr SE
Rower's Phone
5138018244
Select Rowing Group
Middle School/Recreational
USRowing Membership Number
1559155
USRowing Membership Expiration Date
September 9, 2022
USRowing SafeSport
My rower is under 18 years of age
Rower's Birthday
11/062008
Rower's Age
12
Rower's Current School
Randolph School
Rower's Current Grade Level
8
Rower's Height
5'3
Rower's Weight
115 pounds
Rower's Photo

Personal Info

Parent/Guardian(s) & Emergency Contact's Information
Parent/Guardian's Name
Adi Gowda
Parent/Guardian's Phone
5138018244
Parent/Guardian's Email
vinsome2001 AT gmail.com
Parent/Guardian 2 Name
vasudha reddy
Parent/Guardian 2 Phone
5138018244
Parent/Guardian 2 Email
vinsome2001 AT gmail.com
Who should be contacted in case of an emergency?
Parent/Guardian 1
Emergency Contact Name
Madan Gowda
Emergency Contact Phone
5134059120
Rower's Medical & Safety Information
Select Medical Conditions
None of the issues listed here
If a medical condition was selected, please explain here.
none
List known Allergies
none
List any other known Medical Conditions
none
Rower is Physically Able to Row
Yes
Primary Care Physician's Name Name
Dr Angela King
Primary Care Physician's Number
256 7051156
Medical Insurance Provider
BCBS
Medical Insurance Contract/ID #
VHU806678065
Medical Insurance Policy/Group #
78065
Permission to Provide Emergency Care
Yes
Rower has completed an RCRC Swim Test
Yes
When will I Upload the Physical
Agree to have completed and uploaded within 4 weeks - if at all possible
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
Other Information
Where did you hear about RCRC's Rowing Program?
Facebook or other social media
Signature
vasudha reddy
Oct. 16 & 17 Regatta
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
IMAGE - upload Physical Form Page 1 of 2
IMAGE - upload Physical Form Page 2 of 2
FILE - upload Physical Form
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
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
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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!