RCRC Rower Information

Participant Info

Rower's Information
Rower's First Name
Hannah
Rower's Last Name
Ornatowski
Preferred Name
Hannah
Rower's Full Mailing Address
123 Honey Brook Drive Toney, AL 35773
Rower's Phone
256-804-8581
Select Rowing Group
High School/Competitive
USRowing Membership Number
1541973
USRowing Membership Expiration Date
September 20, 2022
USRowing SafeSport
My rower is under 18 years of age
Rower's Birthday
08/23/2004
Rower's Age
17
Rower's Current School
Life Christian Academy
Rower's Current Grade Level
11th
Rower's Height
5'4"
Rower's Weight
135
Rower's Photo

Personal Info

Parent/Guardian(s) & Emergency Contact's Information
Parent/Guardian's Name
Leanna Ornatowski
Parent/Guardian's Phone
256-503-8253
Parent/Guardian's Email
ornatowski AT bellsouth.net
Parent/Guardian 2 Name
A.J. Ornatowski
Parent/Guardian 2 Phone
256-829-0202
Parent/Guardian 2 Email
ornatowski AT msn.com
Who should be contacted in case of an emergency?
Parent/Guardian 1
Emergency Contact Name
Stacey Rhoden
Emergency Contact Phone
256-929-8053
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
low average platelet count which could effect bleeding and causes easy bruising
Rower is Physically Able to Row
Yes
Primary Care Physician's Name Name
Andrea Thorpe
Primary Care Physician's Number
256-428-4950
Medical Insurance Provider
Anthem
Medical Insurance Contract/ID #
HEXAN6613174
Medical Insurance Policy/Group #
270158M1EA
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?
RCRC Website
Signature
Leanna R. Ornatowski
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
IMAGE - upload Physical Form Page 1 of 2
IMAGE - upload Physical Form Page 2 of 2
FILE - upload Physical Form
hannah_sport_physical_p2_1.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
rcrc_code_of_conduct-2.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
rcrc_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