2019-2020 Registration Swimmer InformationSwimmer* First Last Nickname:Address:* Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState / Province / RegionPostal / Zip CodeGender:FemaleMaleDate of Birth:01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990daymonthyearUpload Swimmer Photo (Headshot) for the team roster (.jpg or .gif file format): Grade:Select Grade2nd Grade3rd Grade4th Grade5th Grade6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th GradeCollege FreshmanSchool: Experience:Select ExperienceNoneArlington Parks and RecreationOverleeNoviceIntermediateAge Group 12UAge Group 13-15Age Group 16-18Another TeamOther Experience:Swim Suit Size:Select Size242628303234363840If your swimmer does not have a telephone number or e-mail address, then please leave these fields blank.Phone (Optional): Area Code - Phone Number Phone Type:HomeMobileWorkE-mail (Optional):Guardian & Emergency Contact InformationGuardian (G1):* First Last Relationship (G1):*Select RelationshipMotherFatherLegal GuardianStep-MotherStep-FatherAuntUncleGrandmotherGrandfatherOtherUpload Guardian (G1) Photo (Headshot) for the team roster: Address (G1):* Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState / Province / RegionPostal / Zip CodeE-mail (G1):*Primary Phone (G1):* Area Code - Phone Number Phone Type (G1):*HomeMobileWorkPhone (G1A): Area Code - Phone Number Phone Type (G1A):HomeMobileWorkOnly one guardian is required; however this information will be used in case of emergency. If there are two parents/guardians, then please list both.Guardian (2): First Last Relationship (G2):Select RelationshipMotherFatherLegal GuardianStep-MotherStep-FatherAuntUncleGrandmotherGrandfatherOtherUpload Guardian (G2) Photo (Headshot) for the team roster:Address (G2): Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState / Province / RegionPostal / Zip CodeE-mail (G2):Primary Phone (G2): Area Code - Phone Number Phone Type (G2):HomeMobileWorkPhone (G2A): Area Code - Phone Number Phone Type (G2A):HomeMobileWorkParents/Guardians will be contact first in case of emergency. This individual will be called, if we're unable to reach you. Emergency Contact:* First Last Relationship (EC):*Select RelationshipStep-MotherStep-FatherFamily FriendAuntUncleGrandmotherGrandfatherMotherFatherLegal GuardianOtherPrimary Phone (E1):* Area Code - Phone Number Phone Type (E1):HomeMobileWorkPhone (E2): Area Code - Phone Number Phone Type (E2):HomeMobileWorkPhotography & Media ReleaseThe undersigned authorizes NVS Synchro to permit photographers/videographers employed or designated by NVS Synchro to take photographs and/or film/video footage of and to obtain quotations and information from the undersigned.Such photographs, film/video footage and recorded comments may be used for educational purposes, publications and/or broadcasts which may include but not limited to the following: newspapers, radio, television, staff newsletters, photographic displays, and publicly distributed publications such as annual reports, external newsletters, news releases, pamphlets, brochures, websites, flyers and promotional publications and the undersigned shall be entitled to no compensation as a result of such use from NVS Synchro.May the swimmer's photograph be used in social media, online and in press releases to promote NVS? *YesNoScroll to Select Level & Payment Option:*NOVICE 2 days per week ($75 for first month, ($1,170) for remainder of seasonNovice-Installments $1,170 ($234 over 5 payments)Novice-In Full $1,170 (less 5% = $1,111)INTERMEDIATE 3 days per week ($2,150 for season)Intermediate-Installments $2,150 ($430 over 5 payments)Intermediate-In Full $1,400 (less 5% = $2,042)AGE GROUP 12& Under Team 3 days per week ($2,150 for season)AG 12U-Installments $2,150 ($430 over 5 payments)AG 12U-In Full $2,150 (less 5% = $2,042)AGE GROUP 12& Under Team 4 days per week ($2,380 for season)AG 12U-Installments $2,380 ($476 over 5 payments)AG 12U-In Full $2,380 (less 5% = $2,261)AGE GROUP 13-15 Team - 3 days per week ($2,350 for season)AG 13-15-Installment $2,350 ($470 over 5 payments)AG 13-15-In Full $2,350 (less 5% = $2,232)AGE GROUP 13-15 Team - 4 days per week ($2,950 for season) AG 13-15-Installments $2,950 ($590 over 5 payments)AG 13-15 in Full - $3,000 (less 5% = $2,850)AGE GROUP 13-15 Team - 5 days per week ($3,150 for season) AG 13-15 -Installments $3,150 ($630 over 5 payments)AG 13-15 -In Full $3,150 (less 5% = $2,992)AGE GROUP 16-19 Team – 3 days per week ($2,450 for season) AG 16-19- Installments $2,450 ($490 over 5 payments) AG 16-19--In Full $2,450 (less 5% = $2,327)AGE GROUP 16-19 Team – 4 days per week ($3,200 for season) AG 16-19- Installments $3,200 ($640 over 5 payments) AG 16-19--In Full $3,200 (less 5% = $3,040)AGE GROUP 16-19 Team – 5 days per week ($3,950 for season) AG 16-19- Installments $3,950 ($790 over 5 payments) AG 16-19--In Full $3,950 (less 5% = $3,752)Club DuesThe season runs from September through June. New swimmers receive a discounted rate of $75 during the month of September, while the swimmer and their family try synchro. At the end of the trial period, the swimmer will be assigned a level and the family will indicate, if they wish to continue.Returning swimmers should sign-up for the previous season's level or as instructed by their coach. The coaches will make final placements in the beginning of October. If your swimmer moves up a level, then billing will be adjusted. There are two payment options:A) In installments over the first 5 months of the season.B) In full at the beginning of the season with a five percent discount.At check-out, if you're paying via check, then disregard the 3% PayPal fee (tax). If you have chosen to pay by check , please submit check payments to: NoVa Synchro, Inc. P.O. Box 5712 Arlington, VA 22205If you opt to pay via PayPal, please send payments to nvstreasurer@gmail.com.Thank you in advance for your dues payment. 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