RCRC Rower Information

Participant Info

Rower's Information
Rower's First Name
Katherine
Rower's Last Name
Henderson
Preferred Name
Kat
Rower's Full Mailing Address
101 Overland Trce Huntsville, AL 35806
Rower's Phone
256-542-0026
Select Rowing Group
High School/Competitive
USRowing Membership Number
1451319
USRowing Membership Expiration Date
April 29, 2022
USRowing SafeSport
My rower is under 18 years of age
Rower's Birthday
07/13/2005
Rower's Age
16
Rower's Current School
Sparkman High
Rower's Current Grade Level
11th
Rower's Height
5'5"
Rower's Weight
127#
Rower's Photo

Personal Info

Parent/Guardian(s) & Emergency Contact's Information
Parent/Guardian's Name
Julie Henderson
Parent/Guardian's Phone
256-542-0171
Parent/Guardian's Email
j2hender AT gmail.com
Parent/Guardian 2 Name
Doug
Parent/Guardian 2 Phone
Henderson
Parent/Guardian 2 Email
d2hender AT gmail.com
Who should be contacted in case of an emergency?
Parent/Guardian 1
Emergency Contact Name
Laurel White
Emergency Contact Phone
256-431-2854
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
environmental grass, trees, mold
List any other known Medical Conditions
Hypothyroidism
Rower is Physically Able to Row
Yes
Primary Care Physician's Name Name
Robbie Dudley
Primary Care Physician's Number
256-772-2037
Medical Insurance Provider
BCBS of AL
Medical Insurance Contract/ID #
PQB811663680
Medical Insurance Policy/Group #
76717
Permission to Provide Emergency Care
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
Where did you hear about RCRC's Rowing Program?
Other
Signature
Julie Henderson
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
March 29, 2021
IMAGE - upload Physical Form Page 1 of 2
IMAGE - upload Physical Form Page 2 of 2
FILE - upload Physical Form
kat_sport_physical_2021_front_side_low_res_1.jpg
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
covid_back_low_res_1.jpg
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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