Mentor Marlins Swim Team
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Mentor Marlins Swim Team Online Registration

The following online form combines the Committee / Swim Meet Jobs Sign Up, Medical Release and General Information Signup Document. Once you have filled in the following form, click the submit button at the bottom of the form. This will take you to the secure Paypal site where you will have an option to pay by check or credit card. If you have any questions, please contact us at info@mentormarlins.com

Section 1 - Parent/Guardian Swim Meet Signup

ALL parents are needed to help ensure a smooth swim meet.  As opposed to other sports, there are a lot of things that need to be done – that are CRITICAL to having a successful meet. Each family is required – either a few hours at each meet or to chair a specific committee for all the meets.  There are simply too many things that need to be done for “the same people” to do all of the jobs each week! We will do our best to honor your choices, but bear in mind that all jobs need to be done!

Please indicate your “1st”, “2nd” or “3rd” choice to help the team

             Committee Head        Help at meets for 2 hours         Would you like to be on the board next year?

Concessions                                                                                 President          

Official                                                                                            Vice President 

Runner                                                                                             Secretary         

Set up/Clean up                                                                              Treasurer        

Scoring                                                       

Timing                                                         

Banquets                                                     

Medals / Awards   

Parkview Sizzler                                         

Spaghetti Dinner                                           

Swim-A-Thon                                              

Section 2 - Medical Information / Consent

In consideration of acceptance of the City of Mentor Swim Team, I, the undersigned (an electronic acceptance is used in lieu of a signature), on behalf of myself, my heirs, and administrators forever do release and waive all rights and claims for damage or recompense due to injury growing out of participation/spectatorship in the swimming program insofar as the City of Mentor Parks and Recreation is concerned.  Acceptance via electronic signature further attests that the swimmer(s) is/are physically and psychologically healthy to participate in the sport of swimming. 

PART 1

EMERGENCY MEDICAL AUTHORIZATION – GRANTING CONSENT: 

In the event reasonable attempts to contact me at (Home) or (Work) or  (Cell) have been unsuccessful, I hereby consent for: 

1)     The administration of any treatment deemed necessary by a physician or dentist

2)     The transfer of the child to any hospital reasonably accessible 

This authorization does not cover major surgery unless the medical opinion of two licensed physicians or dentists, concurring in the necessity for such surgery are obtained prior to the performance of such surgery. 

Facts concerning the child’s medical history, including allergies, medication being taken at present, and any physical impairment to which swimming coaches or physicians should be alerted. 

Swimmer’s name: Fact: 

Swimmer’s name: Fact: 

Swimmer’s name: Fact:

Swimmer's name: Fact:

Swimmer's name: Fact:

Medical Insurance Carrier    ID or Group or Contract #

 Parent / Guardian Acceptance (Y / N)  

PART II

EMERGENCY MEDICAL AUTHORIZATION – REFUSAL TO CONSENT 

I do not give my consent for emergency medical treatment of my child.  In the event of illness/injury requiring emergency treatment, I want the City authorities to TAKE NO ACTION or TO DO THE FOLLOWING:  

Parent / Guardian Acceptance (Y / N)   ONLY SELECT YES IF YOU DO NOT WANT MEDICAL ATTENTION FOR YOUR CHILD IN THE EVENT OF AN EMERGENCY      

Section 3 - Swimmer Information

Swimmer’s Last Name First Name

                             Format for birth date 00/00/0000 month/day/year

Birth Date                           

Swimmer’s Last Name First Name

Birth Date                             

Swimmer’s Last Name First Name

Birth Date                             

Swimmer’s Last Name First Name

Birth Date                             

Swimmer’s Last Name First Name

Birth Date                              

 

Parent /Guardian Last Name      Home Phone  

Address       City   Zip  

E-Mail            

 

Mother's First Name     Work Phone   Cell Phone

                                                                                                     

Father’s First Name      Work Phone   Cell Phone

                                                                                                    

Section 4 - Swimmer T-shirt Size Selection & Personalization

All swimmers receive 1 free Mentor Marlins t-shirt with paid registration. If you would like the t-shirt personalized with a name, please fill in the information below.  You must add $5.00 per swimmer to the registration fees.

Swimmer 1 Size

Name on Shirt     

Swimmer 2 Size

Name on Shirt     

Swimmer 3 Size

Name on Shirt    

Swimmer 4 Size

Name on Shirt   

Swimmer 5 Size

Name on Shirt    

Section 5- Fee Schedule

Please use the fee chart below.

      Mentor Residents                  w/ Personalized T-shirts

1 Swimmer(s)            110.00                          115.00

2 Swimmer(s)            180.00                          190.00   

3 Swimmer(s)            243.00                          258.00

4 Swimmer(s)            306.00                          326.00

5 Swimmer(s)            369.00                          394.00 

     Non-Mentor Residents          w/ Personalized T-shirts

1 Swimmer(s)           125.00                          130.00

2 Swimmer(s)           210.00                          220.00

3 Swimmer(s)           286.50                          301.50

4 Swimmer(s)           363.00                          383.00

5 Swimmer(s)           439.50                          464.50

Please review all of the information above before you click the submit button. Once you select the submit button, you will not be able to make any changes. You will then be directed to the secure site of Paypal where you will enter your payment information. Please use the chart above to enter the total payment amount. Do not click the back button or you will have to re-enter all of the data.

GOOD LUCK AND HAVE A GREAT SWIMMING SEASON!

DO NOT CLICK THE SUBMIT BUTTON MORE THAN ONE TIME

YOU WILL BE DIRECTED TO THE PAYPAL SITE TO MAKE YOUR PAYMENT

THIS MAY TAKE UP TO 30 SECONDS...PLEASE BE PATIENT