Junior Swim Team Out-of-Town Meet Consent

Swimmer Information

Swimmer's Name Date of Birth

Parent/Guardian Information

Parent/Guardian Name Contact Number

Out-of-Town Meet Details

Event Name Location Date(s) of Meet

Medical Information

Allergies or Medical Conditions Emergency Contact Name Emergency Contact Phone

Consent Statement

I hereby give permission for my child to participate in the above out-of-town swim meet and authorize the team coaches/chaperones to act on my behalf in an emergency.

Parent/Guardian Signature

Signature Date