RCRC Rower Information

Participant Info

Rower's Information
Rower's First Name
Alison
Rower's Last Name
O'Halloran
Preferred Name
Ali
Rower's Full Mailing Address
2905 Southhurst DR Huntsville, AL 35803
Rower's Phone
256 631 9829
Select Rowing Group
High School/Competitive
USRowing Membership Number
1559520
USRowing Membership Expiration Date
September 11, 2022
USRowing SafeSport
My rower is under 18 years of age
Rower's Birthday
12/20/2004
Rower's Age
16
Rower's Current School
Grissom High School
Rower's Current Grade Level
11th
Rower's Gender
Female
Rower's Height
5'4"
Rower's Weight
120
Rower's Photo

Personal Info

Parent/Guardian(s) & Emergency Contact's Information
Parent/Guardian's Name
Leanne O'Halloran
Parent/Guardian's Phone
256 655 5300
Parent/Guardian's Email
irishgravel20 AT gmail.com
Parent/Guardian 2 Name
Sean O'Halloran
Parent/Guardian 2 Phone
256 783 7593
Parent/Guardian 2 Email
Who should be contacted in case of an emergency?
Parent/Guardian 1
Emergency Contact Name
Sam and Jill Gravel
Emergency Contact Phone
256 653 2945
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. Brian Patz
Primary Care Physician's Number
256 888 5437
Medical Insurance Provider
Anthem Blue Cross
Medical Insurance Contract/ID #
UNR662M89721
Medical Insurance Policy/Group #
C20879M6A1
Permission to Provide Emergency Care
Yes
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
Other Information
Payment Options
Check made out to Rocket City Rowing Crew to be brought to RCRC
Rower's T-Shirt Size
S
Where did you hear about RCRC's Rowing Program?
Facebook or other social media
Signature
Leanne O'Halloran
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
December 2, 2020
IMAGE - upload Physical Form Page 1 of 2
IMAGE - upload Physical Form Page 2 of 2
FILE - upload Physical Form
ali_phy_form.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
rcr_coc.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
rcr_covid.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