Mt. Lebanon Aqua Club Registration Form

Swim Group
Season
Last Name	Legal First Name	Middle Name

Preferred Name	Date of Birth (mm/dd/yyyy)	Gender
Person Responsible for Billing First name: Last name:
Mailing Address

City

State

ZIP Code

Area Code

Telephone Number

Parent's Email Address(for Billing/Roster)

Other Email Address(for Updates/Announcements)

Disability
	Legally Blind of Visually Impaired
	Deaf or Hard of Hearing
	Physical Disability
	Cognitive Disability
	None of the Above

Ethnicity (in accordance with US. Census Bureau guidelines, you may make up to two choices, if appropriate)
	African American
	Asian
	Caucasian
	Hispanic
	Native American
	Other
	Decline

Are you a US Citizen? Yes No
Are you a member of another FINA federation? Yes No
If yes, which federation?

New MLAC swim members who are current USA Swimming members

Year Last Registered: If you registered with a different club, enter that Club Code:
LSC Code: and date of last competition representing that Club:

Contact Name	Relationship	Home Phone	Business Phone	Cell Phone
Emergency Contact Information

Physician Name	Phone
Dentist Name	Phone
Hospital Preference
Please list any medical conditions, medications, and allergies

I understand that by registering, I am responsible for payment of all fees in accordance with MLAC policies.

MLAC PARENT CODE OF CONDUCT

The MLAC program is proud to have a supportive group of parents throughout the swim groups.

To maintain this standard and expectation of positive parental support, MLAC has adopted the

following Parental Code of Conduct for all parents while their child is a member of MLAC.

* I will act as a role model for my child and other swimmers. I realize my behavior at meets

or at practice can negatively influence my child's development as a swimmer and an

individual. I realize that my actions at meets and practices are a reflection on MLAC and

myself.

* I will not coach my child during meets, practices or in the home. If my child or I have

questions regarding coaching, I will encourage my child to discuss the issues with the coach,

or I will discuss the issues with the coach at an appropriate time and manner. If this does not

resolve the issue, I will schedule a meeting with the personnel committee of MLAC to review

the situation.

* I will demonstrate good sportsmanship at meets, practices and swim functions. I will

not stand on deck and discuss issues with the coach at swim meets or practices. I will not

confront officials with questions during a meet. The coach of MLAC will address officials

with all swimmer or parental concerns. I realize the coach has the responsibility of coaching

and providing a safe environment for all the children of that group. Also, it is against the

USA swim insurance policy for parents (or anyone not registered with USA Swimming or

authorized by meet officials) to be on the pool deck during practices and meets.

* I will not physically touch or use abusive language, inappropriate or intimidating

gestures or name calling when addressing coaches. I voluntarily subject myself to the

appropriate disciplinary action, which may be suspension, or expulsion from the club as

decided by the MLAC board. I realize my first offense will be documented, I will receive a

copy, and the original will remain on file. I understand the first or second offense, depending

on the severity, may result in expulsion from MLAC.

I acknowledge that I have read and understand the Code of Conduct

Swimmer Info

Teams

Parent Info

Mt. Lebanon Aqua Club Registration Form

Disability

Ethnicity

New MLAC swim members who are current USA Swimming members

Emergency Contact Information

MLAC Volunteer Opportunities