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Summer 2021 Swim and Dive Registration Form (post 5/31))

Welcome to the 2021 Registration for Fairfax Swim and Dive. All team members must have a stockholding family membership at Fairfax Swimming Pool to participate. Provisional Family members are also eligible for our Swim and Dive Teams. If you do not already have a stock certificate or a Provisional Family membership, please visit the Fairfax Swimming Pool website to become a member. 

Please use this form only for Swim and/or Dive. If you are interested in the Tadpoles program, please click here.

Parent/Guardian Information

At least one parent/guardian registration is required.
New accounts will be sent an email confirmation message with instructions to setup a password.

At least one parent/guardian email address must be provided.
Check the boxes to indicate which parent/guardians should receive team-wide emails.

First Name * Last Name * Email Address *
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Primary Phone

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Athlete Information

Enter the information for each athlete being registered below. At least one Athlete registration is required.

First Name * Preferred Name Middle Initial Last Name * Gender * Birth Date *
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Home Address

Membership Stock Certificate or Provisional Family #

Please provide your FSP Stock Certificate Number or Waitlist Number (please note this is not the same as your Member ID number). If you have not yet joined Fairfax Swimming Pool, please visit fairfaxpool.com/Membership to join. (Current members can find their stock certificate/PF number by logging into their account at fairfaxpool.com) *

Winter/USS Swimming

Does your swimmer participate in a winter swim or other USS Swim program? (For NVSL team seeding purposes only.) *

Participation Waiver

As Parent/Guardian of the above-name minor(s), I grant permission for the swimmer(s)/diver(s) to participate in all activities of the Fairfax Swimming Pool Swim/Dive Team, a Northern Virginia Swimming League (NVSL) member team. I represent and warrant that my minor child/children participating on the Fairfax Swimming Pool Swim/Dive Team are in good health and have no physical condition, ailment or disability which renders them unable to participate in vigorous physical activity. For and in consideration of benefits derived from participation in the Fairfax Swimming Pool Swim/Dive Team program, I understand that the risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury/illness does exist. I assume all risks and hazards arising out of, or related to, such participation, including, but not limited to, transportation to and from such activities, and do hereby indemnify, release and hold harmless Fairfax Swimming Pool, Inc. and its directors, the Fairfax Swimming Pool Swim/Dive Team, its coaches, team representatives, volunteers, property manager, employees and agents, as well as the Northern Virginia Swimming League, from all claims of any kind whatsoever which may arise or hereafter accrue in connection with my child’s/children’s participation in activities of the Fairfax Swimming Pool Swim/Dive Team. I further grant permission for first aid to be given to my child/children in an emergency, and will be solely responsible for any medical costs which may arise. I AGREE THAT THEY WILL ABIDE BY THE NORTHERN VIRGINIA SWIMMING LEAGUE CODE OF CONDUCT

COVID-19 ADDENDUM

An inherent risk of exposure to COVID-19 exists in any public place where people are present. COVID-19 is a contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and individuals with underlying medical conditions are especially vulnerable.

The Northern Virginai Swimming League (NVSL) cannot prevent you (or your child(ren)) from becoming exposede to, contracting, or spreading COVID-19 while participating in NVSL sanctioned events. It is not possible to prevent against the presence of the disease. Therefore, if you choose to participate in a NVSL sanctioned event, you may be exposing yourself to and/or increasing your risk of contracting or spreading COVID-19.

By attending or participating in practice or competition, you voluntarily assume all risks associated with exposure to COVID-19 and forever release and hold harmless the Fairfax Frogs Swim and Dive Team, its coaches, team representaives, volunteers, property manager, employees and agents, as well as the Northern Virginia Swimming League and its officers, directors, agents, employees or other representatives from any liability or claims including for personal injuries, death, disease, or property losses, or any other loss, including but not limited to claims of negligence, and give up any claims you may have to seek damages, whether known or unknown, foreseen or unforeseen, in connection with exposure, infection, and/or spread of COVID-19 related to participation in practice or competition.

Tewams and their pools have taken enhanced health and safety measures for all attending meets; however, we cannot guarantee that you will not become infected with COVID-19. All attending practices and meets must follow all posted instructions while in attendance. An inherent risk of exposure to COVID-19 exists in any public place where people are present. By attending, you acknowledge the contagious nature of COVID-19 and voluntarily assume all risks related to exposure to COVID-19.

By choosing to attend practices and meets, you agree to comply with all health and safety mandates and guidelines of the Commonwealth of Virginia, your local government, and the pool at which you are participating, either at your home pool or while competing at another NVSL member pool.

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Enter your initials to indicate acceptance: *
Authorization to Take and Use Photographs/Video

I consent to my son(s)/daughter(s) being photographed or video recorded by Fairfax Frogs Swim & Dive Team and/or Fairfax Swimming Pool while participating in team supervised events, such as practices, meets or other team-sponsored gatherings, with purposes including instructional feedback, team and/or pool promotion, or recognition of achievement.

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Enter your initials to indicate acceptance: *