2018-2019 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):HomeMobileWork Only 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):HomeMobileWork Parents/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 ReleaseNoVa Synchro activities, practices, events, and competitions are sometimes videoed and photographed for news and social media purposes. May the swimmer's photograph be used in social media, online and in press releases to promote NVS? *YesNoClub 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). Scroll to Select Level & Payment Option:*New Swimmer-September Only ($75)NOVICENovice-Installments $1,080 ($216 over 5 payments)Novice-In Full $1,080 (less 5% = $1,026)INTERMEDIATEIntermediate-Installments $1,400 ($280 over 5 payments)Intermediate-In Full $1,400 (less 5% = $1,330)AGE GROUP 12 & UNDERAG 12U-Installments Team Only $1,700 ($340 over 5 payments)AG 12U-In Full Team Only $1,700 (less 5% = $1,615)AG 12U-Installments Solo or Duet plus Team $2,200 ($440 over 5 payments)AG 12U-In Full Solo or Duet plus Team $2,200 (less 5% = $2,090)AGE GROUP 13-15AG 13-15-Installments Combo Only $1,600 ($320 over 5 payments)AG 13-15-In Full Combo Only $1,600 (less 5% = $1,520)AG 13-15-Installments Team & Combo $2,400 ($480 over 5 payments)AG 13-15-In Full Team & Combo $2,400 (less 5% = $2,280)AG 13-15-Installments Solo or Duet plus Team & Combo $3,000 ($600 over 5 payments)AG 13-15-In Full Solo or Duet plus Team & Combo $3,000 (less 5% = $2,850)AGE GROUP 16-19AG 16-19-Installments Combo Only $1,600 $320 over 5 payments))AG 16-19-In Full Combo Only $1,6000 (less 5% = $1,520)AG 16-19-Installments Team & Combo $2,400 ($480 over 5 payments)AG 16-19-In Full Team & Combo $2,400 (less 5% = $2,280)AG 16-19-Installments Solo or Duet plus Team & Combo $3,000 ($600 over 5 payments )AG 16-19-In Full Solo or Duet plus Team & Combo $3,000 (less 5% = $2,850)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. Payment Method: CheckPayPalVerification:SubmitReset