MANHASSETINTERSCHOLASTICATHLETICS
HEALTHFORMANDPOWEROFATTORNEY
Iherebyauthorizeandempower**Seebelow(supervisororcoach)tosecurenecessary
andrequiredmedicalaidformydaughter/son______whileintheircare.
Further,ifanyemergencyshouldarisenecessitatingsurgerybyareasonofillnessor
accident,thesaidsupervisororcoachshallexecuteanymedialorhospitalauthorizationfor
andinmybehalfasifIwerepersonallypresent.
Itisagreedandunderstoodthatpriortoexercisingtheabovepowerofattorneyinthe
eventofemergency,theabovenamedsupervisororcoachshallmakeeveryeffortto
contacttheparentorguardianfororalapprovalordisapproval.
Student'sName:______DateofBirth:______
HomeAddress:______
Town:______State:______Zip:______
ParentorGuardian:______
HomePhone:______WorkPhone:______CellPhone:______
EmergencyContact:______Phone:______
FamilyPhysician:______Phone:______
Doesyourchildhaveproblemswithanyofthefollowing:
__Asthma
__SkinConditions
__HearingLoss
__AllergytoInsectSting
__FoodAllergies
__SleepWalking
__Seizures
__Other:______
Isyourchildallergictoanymedications?______
Isyourchildcurrentlytakinganymedication?____Ifso,what?______
SpecialInstructions:______
MedicalInsuranceCoveredby:______
CompanyName:______
PolicyNumber:______
ParentorGuardianSignature:______
**** Steve Panzik, Chris M are, Rachel Roth, Ty Lewis, Tom Keegan, Jessica Sims, Jason Rich
MANHASSETCREWSWIMTEST
ToparticipateinonwatertrainingwiththeMANHASSET
CREWTEAManathletemusthaveanactiveswimtest
formsubmitted.
Theformisvalidthroughhis/herrowingcareerat
MANHASSETCREW.
Thetestconsistsofswimming100yardsinapool(any
strokeanytime),aftertheathletemusttreadwaterfor
10minutes.
ContactthelocalYMCA,JCC,orotherrecreationalpoolto
setupatesttime.Youmayfinditeasiertobookasa
group.
Theformrequiresaregisteredlifeguard'ssignatureto
cleartheathlete.
IfyouparticipatedontheMiddleSchool/HighSchool
swimteampleasehaveyourcoachfillouttheform.
MANHASSETCREWTEAMSWIMTESTFORM
MANHASSETCREWTEAMrequiresthatallathletesdisplayadequateswimming
skillsBEFOREfirstdayofpractice.
1.WriteNameofParticipantonSwimTestForm.
2.HaveaCertifiedLifeguard/WaterSafetyInstructor/SwimmingCoachobserve
youandcompletetheformbelow.
3.Makeacopyofyourformforyourrecords.
NameofParticipant:______
NameofLifeguard/WaterSafetyInstructor:______
NameofPool:______
PhoneNumberofPool:______
SwimTestCertification
Iherebycertifythattheparticipantcanswim100yardsinacompetentmanner
(anystroke)andcantreadwaterfor10minutes.
______
SignatureofLifeguard/WaterSafetyInstructor
______
DateofTest
Keepacopyofthecompletedswimtestforyourrecords.
STANDARDPHOTOandGENERALRELEASEFORM
FRIENDSOFMANHASSETCREW,INC.
IherebyauthorizeFriendsofManhassetCrew,Inc.("FOMC")topublishthephotographs
takenatcrewregattas,teampractices,andotherfundraisersofmeand/ortheundersigned
minorchildrenforanypublicrelationspurpose,includingbutnotlimitedtoprintedmaterial,
localnewspapers,videoorwebsites.
IreleaseFOMCfromanyexpectationofconfidentialitywithrespecttothephotographed
imagesoftheminorchildrenlistedbelowandmyselfandattestthatIamtheparentor
legalguardianofthechildrenlistedbelowandthatIhavetheauthoritytoauthorizeFOMC
tousetheirphotographsandnames.
Iacknowledgethatsinceparticipationinanyoftheaforementionedpublicationsand
websitesproducedbyFOMCisvoluntary,neithertheminorchildrenlistedbelownorIwill
receivefinancialcompensation.
IfurtheragreethatparticipationinanypublicationandwebsiteproducedbyFOMCconfers
norightsofownershiptomewhatsoever.
IfurtherreleaseFOMC,itscontractorsanditsemployeesfromliabilityforanyclaimsbyme
oranythirdpartyinconnectionwithmyparticipationortheparticipationoftheminor
childrenlistedbelow.
Iacknowledgethatparticipationinthesportofrowinginvolvesinherentrisk,andIreadily
assumeallriskstomyminorchild(ormeifIamovertheageof18).Icertifythatmychild
(ormeifIamovertheageof18)isacompetentswimmerandcantreadwaterforan
appropriateamountoftimeifashellwastotipoveruntilhelpreacheshim/her.
Parent’sName:______
Parent’sSignature:______Date:______
StreetAddress:______
City,State,Zip:______
NamesandAgesofMinorChildren:
Name:______Age:_____
Name:______Age:_____
Student’sName(onlyifage18orolder):______
Student’sSignature(onlyifage18orolder):______