Adult Swim Sign-Up Form

* Name

* Primary Phone

* Email Address

Contact and Swimmer Information

This information is required only if this is the first West Austin form you have completed in 2010.

Address

City

Zipcode

Additional Contact Phone Numbers - Home, work, cell

Doctor to call in an emergency

List any medical information that the swim staff should know including allegies, medications, disorders, seizures, asthma, anything you think important

Swimmer 1

Swimmers First Name

Last Name

Gender

Past Swim Team Experience

Check here:

I have a single or family membership

I am not a member, but want to join

Swimmer 2

Swimmers First Name

Last Name

Gender

Past Swim Team Experience

Check here:

I have a family or single membership

I am not a member, but want to join

Medical Information & Consent

I understand the nature of fitness activities of West Austin Athletic Club, and my experience and capabilities and believe I am qualified to participate in such activity. I hereby release, discharge, covenant not to sue, and AGREE TO IDEMNIFY AND SAVE AND HOLD HARMLESS each of the Releasees (West Austin Athletic Club, their administrators, directors, agents, owners, members, volunteers, and employees) from all liability, claims, demand, losses, or damages on my account caused or alleged to be caused in whole or in part by the negligence of the Releasees or otherwise including negligent rescue operations, and further agree that if, despite this release, I or anyone on my behalf makes a claim against any of the above Releases, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS each of the Releasees from any litigation expenses, attorney fees, loss liability, damage, or cause any may incur as the result of any such claim.

I give West Austin Athletic Club and its Releasees permission to perform medical treatment as needed.

You must check here

I agree to abide by the rules and regulations of the West Austin Athletic Club.

You must check here

Payment Options

PAY ONLINE - We use Google Checkout for payments and charge a 3% online processing fee. On the next screen, click the Google Checkout image.

PAY BY CHECK - On the next screen, click pay by check, print the summary page and mail to the address shown

BILL ME, I AM A MEMBER - On the next screen, click pay by check and we will add the charges to your monthly bill

* Indicates Response Required