RCRC Rower Information

Participant Info

Rower's Information
Rower's First Name
Xavier
Rower's Last Name
Waninger
Preferred Name
Rower's Full Mailing Address
143 Manningham Drive Madison, AL 35758
Rower's Phone
256-631-5176
Select Rowing Group
High School/Competitive
USRowing Membership Number
1519725
USRowing Membership Expiration Date
September 18, 2022
USRowing SafeSport
My rower is under 18 years of age
Rower's Birthday
05/17/2005
Rower's Age
16
Rower's Current School
bob Jones High School
Rower's Current Grade Level
11th
Rower's Height
6'3"
Rower's Weight
148
Rower's Photo

Personal Info

Parent/Guardian(s) & Emergency Contact's Information
Parent/Guardian's Name
Terra Waninger
Parent/Guardian's Phone
256-663-9116
Parent/Guardian's Email
stwaninger AT knology.net
Parent/Guardian 2 Name
Sean Waninger
Parent/Guardian 2 Phone
256-542-8950
Parent/Guardian 2 Email
stwaninger AT knology.net
Who should be contacted in case of an emergency?
Parent/Guardian 1
Emergency Contact Name
Deanna Blessinger
Emergency Contact Phone
812-482-7720
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
Charlotte Meadows
Primary Care Physician's Number
256-772-2037
Medical Insurance Provider
BCBS
Medical Insurance Contract/ID #
BHP833604449
Medical Insurance Policy/Group #
7NUS60
Permission to Provide Emergency Care
Yes
Rower has completed an RCRC Swim Test
Unsure
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
Where did you hear about RCRC's Rowing Program?
Other
Signature
Terra Waninger
Oct. 16 & 17 Regatta
Both Days
Nov 13 Regatta
Attend
**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
September 5, 0021
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
rcrc_code_of_conduct_1.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
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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