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District Swim Meet – June 30, 2016 State Swim Meet – July 15 – 16, 2016 Copy of Birth Certificate required with form PLEASE PRINT CLEARLY Participant’s Name Participant Age Group Swim Team Name Unattached Swimmer - Check if unattached Parent E-mail Address Address City Zip Home Phone Work Phone Mother’s Name Cell Phone Father’s Name Cell Phone Emergency Contact Phone Date of Birth / / Age Sex Grade School Medical Conditions/Allergies Current Medications List Stroke Preference, in order: If selected for a relay team only, I will attend and participate: Yes No Refund Policy: No refunds or credits granted once entries have been submitted to GRPA District/State. If you request a refund at least 5 days prior to District/State submittal, you have two options: Receive an immediate credit for the full amount; or Receive a refund, minus a 25% administration fee. Online Registration Convenience Fees are non-refundable. Concussion Policy: In order to register, parents must initial here to confirm the following: I, the parent/guardian hereby acknowledge receiving concussion information. I accept my responsibility to report my child’s to OCPRD staff, coaches, and health care providers. I understand that my child must not have any concussion before returning to play and must have written permission from a health care provider trained in concussion management before returning to play. OCPRD District Team Selection and Regulations: 1. The District team will be selected by the swim committee, also known as the All Star Selection Committee, made up of two swim representatives from each team. It is preferable that one of the swim team representatives is the team coach. 2. To be eligible for the All-Star swim team a swimmer must be: a. Committed to attend both the District and State Swim Meets prior to the beginning of the All Star Selection meeting. b. An Oconee county resident, attend school in Oconee County or adhere to the GRPA residency exception stating that any counties that adjoin Oconee and do not have a swim program can participate with Oconee as long as the county is in GRPA District 7 and in the same classification Currently this only applies to Oglethorpe County. c. Between the ages of 7 -18 years as of May 31. d. Registered with OCPRD and pay registration fee ($20 for District Meet; additional $20 for the State Meet). e. A participant in two Oconee Swim League meets or league approved meets during the current season, unless unattached. (Exception: Swim committees approves participant to swim to fill empty relay positions if necessary) 3. Swimmers can be entered in only two individual events and two relays. Coaches will determine selection of events for swimmers. 4. District entries will be submitted by an OCPRD staff member based on GRPA deadline. Once the entries have been submitted, no changes may be made – submitted entries are final. 5. If a swimmer is selected for the District or State meet and fails to fully participate in all events entered, the swimmer will not be eligible to represent Oconee County in the District or State meet the following year. Any subsequent occurrence will result in suspension from the swim league for two years. Appeal process is outlined in Oconee Swim League rules and regulations. 6. Following participation in the District meet, if a swimmer only qualifies as an alternate in the State Meet, the swimmer will be given the option to withdraw without penalty. Parent/Guardian Signature Date WAIVER ON BACK MUST BE SIGNED TO PROCESS REGISTRATION 2016 Oconee County Swim - District and State Commitment OVER ---PAGE BREAK--- PARTICIPANT WAIVER & RELEASE OF LIABILITY MUST BE SIGNED TO PROCESS REGISTRATION In consideration of the named participant being allowed to participate in any way in the Oconee County Parks and Recreation Department programs, related events and activities, I, the parent/ legal guardian, of the named child, or as an adult participant, hereby acknowledges, appreciates, and agrees to the following: 1. The risk of injury or damages to my child and/or myself from the activities involved in the 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 does exists; and, 2. FOR MYSELF, SPOUSE AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and, 3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives, and next of kin, HEREBY INDEMINFY AND HOLD HARMLESS the Oconee County, Board of Commissioners, and all employees or agents of Oconee County, including all individuals who are affiliated with the programs administered by the Parks and Recreation Department of Oconee County (“Releases”), from any and all liabilities incident to my involvement or participation in these programs or transportation to and from activities, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE, to the fullest extent permitted by law. 4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives, and next of kin, HEREBY RELEASE THE other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my and/or my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 5. I hereby grant consent to any and all first aid responders designated by the Oconee County Parks and Recreation Department to provide my child any necessary medical care as a result of any injury/illness. This consent includes First Aid and transportation to/from first aid responders. 6. I further understand that health, or accident insurance which would cover my or my child's medical, hospital, or related expenses in the event of injury in this activity is my responsibility. I understand the Parks & Recreation Department of Oconee County strongly recommends that if I do not have sufficient insurance to cover such incidents that I should take the necessary action to obtain it. 7. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my or my child’s readiness for participation and/or in the program itself, I will remove myself or my child from the participation and bring such attention of the nearest official immediately; and, 8. I understand that I am bound to abide by the Oconee County Parks & Recreation Department's Code of Conduct. I further understand that these programs are recreational and that if either parent should exhibit continued unsportsmanlike conduct, the child may be removed from the program. 9. I understand that the department may use participant images or videos, and that such may be published in an outlet used to promote or publicize the program or department. 10. I, the undersigned, agree to abide by the rules stated above as well as the rules and regulations of The Oconee Swim League and the Georgia Recreation and Parks Association swim regulations. I also understand that swimmers will be selected in order to put together the fastest team possible for each event. I further understand that my signature on this form commits us to participate at both the district and state meets, if qualified. I HAVE READ THIS RELEASE OF LIABILITY, ASSUMPTION OF RISK AGREEMENT AND WAIVER. I FULLY UNDERSTAND ITS TERMS, I UNDERSTAND I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Parent/Guardian Signature Date ---PAGE BREAK--- PARENT/GUARDIAN CONCUSSION INFORMATION What is a Concussion? A type of traumatic brain injury caused by a bump, blow, or jolt to the head or body that causes the head and brain to move rapidly back and forth, changing the way the brain normally works. Did You Know? Most concussions occur without loss of consciousness. Signs and of concussion can show up right after the injury or may not appear or be noticed until days or weeks after the injury. Athletes who have, at any point in their lives, had a concussion have an increased risk for another concussion. Young children and teens are more likely to get a concussion and take longer to recover than adults. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious. Why Should An Athlete Report Their If an athlete has a concussion, his/her brain needs time to heal. Rest is key in recovering. While an athlete’s brain is still healing, s/he is much more likely to have another concussion. Repeat concussions can increase the time it takes to recover. In rare cases, repeat concussions in young athletes can result in brain swelling or permanent damage to their brain. They can even be fatal. What Should You Do If You Think Your Athlete Has A Concussion? 1. Remove your child from play. 2. Do not try to judge the severity of the injury. 3. Seek medical attention. 4. Keep the athlete out of play until a health care professional, experienced in evaluating for concussion, says it is okay to return to play. SIGNS OBSERVED BY COACH/PARENT REPORTED BY ATHLETES Appears dazed or stunned Headache or “pressure” in head Is confused about assignment or position Nausea or vomiting Forgets an instruction Balance problems or dizziness Is unsure of game, score, or opponent Double or blurry vision Moves clumsily Sensitivity to light Answers questions slowly Sensitivity to noise Loses consciousness (even briefly) Feeling sluggish, hazy, foggy, or groggy Shows mood, behavior, or personality changes Concentration or memory problems Can’t recall events prior to hit or fall Confusion Can’t recall events after hit or fall Just not “feeling right” or “feeling down” The Following Concussion Danger Signs Represent a Medical Emergency: Athlete has one pupil larger than the other, is drowsy or cannot be awakened, has a headache that not only does not diminish but gets worse, has weakness, numbness, or decreased coordination, repeated vomiting or nausea, slurred speech, convulsions or seizures, cannot recognize people or places, becomes increasingly confused, restless, or agitated, has unusual behavior, and/or loses consciousness. It is better to miss one game than the whole season. When in doubt, sit them out. For more information on concussions, visit: www.cdc.gov/Concussion. PARENT/GUARDIAN ACKNOWLEDGEMENT In order to register, parents must initial on the Registration Form or check the box online to confirm the following: I, the parent/guardian hereby acknowledge receiving concussion information. I accept my responsibility to report my child’s to OCPRD staff, coaches, and health care providers. I understand that my child must not have any concussion before returning to play and must have written permission from a health care provider trained in concussion management before returning to play.