www.LesCitadinsNatation.com • www.facebook.com

Swimmer identification (repeat this page for every swimmers registered)
Name:
First name :
Birth date (AA/MM/JJ):
Citizen card No (Grants) :
email:
School:
Address:
School boards:
Municipality:
School level:
Postal code:
Medical file of the swimmer
Expiration date:
Medical card No:
Medical profile:
Medications:
Allergies (specify):
Epipen (Yes/No):
Past serious injuries:
The swimmer can administer its own medicine
(Yes/No):
Check the size of the T-Shirt (the sizes are not guaranteed)
Youth small:
Youth medium:
Youth large:
Other: (prostheses, contact lenses etc...) :
Adult small:
Adult medium:
Adult large:
Code of conduct of the swimmer
I am a member of Les Citadins Natation, as a swimmer:
I promise to arrive on time with my equipment (bathing suit, goggles, and cap) ready to practice.
I will pay attention to the advice given by my coach and I promise to work my hardest to attain the effort required to improve.
The training may be difficult but I must try to reach my full potential.
I will work to the best of my ability and talent
I will be present at all practices and participate in all competitions
I will treat all equipment with respect (kick boards, pull buoy, racing lanes and locker baskets).
I will show my team spirit by wearing the team uniform
I will respect my coach, my team mates, swimmer of other clubs and officials
I will always speak respectfully in a non-threatening manner...
I promise to abide the code of conduct of the Club.
Signature: ___________________________________________ (If more than 11 years old or of the parents)
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Identification des parents
Father:
Name:
Mother:
Name:
First name:
First name:
Cellular phone:
Cellular phone:
Home phone:
Home phone:
email :
email :
Check the desired option
Tax receipt to the father:
Tax receipt to the mother:
Code of conduct of the parents
I am a member of Les Citadins Natation, as a parent:
I will be respectful at all times with the coaches, athletes, officials and other parents.
I will communicate with the coach if the child must be absent more than three consecutive trainings.
I will talk with the coach after the practice or make the arrangement for a meeting in person, by phone or by e-mail to discuss a
problematic situation with my child.
I will respect the final decision taken by the coaches concerning the placement of my child.
I will let the coach take care of behavior problems and will not intervene on the pool deck.
I will get Involve by following at least one new official training per year and to give of my time as a volunteer official at three
competitions.
I will communicate with the person responsible of volunteers the time I invested in training and volunteering to help with the system of
points earned.
I will notify the coach as soon as possible if the swimmer cannot attend the competition for which he is registered.
I will encourage athletes’ swimmers to persevere, to excel and to be proud of them.
I promise to abide the code of conduct of the Club.
Signature: ___________________________________________
Mandatory volunteering
A $ 50 check post-dated to June 1st per family is requested at registration time as deposit for volunteering. Once your family meet the
following criteria, your check will be returned to you:
Attend a training clinic for officials.
And two activities among those:
Official in one or more meets.
OR
Timekeeper or volunteer. To obtain recognition for your contribution a timekeeper or volunteer feel this online form.
Signature: ___________________________________________
Consent to be photographed
I consent that my children will be photographed and I authorize Le Club de Natation Les Citadins and the school program to use the pictures of
my children in promotion documents such as newspaper articles, local publicity, on the web site and on Facebook
Signature: ___________________________________________
Transportation consent
By signing this form, I allow my children to be part of the swimming activities of Le Club de Natation Les Citadins and if necessary, I authorize
him/her to travel in a vehicle driven by coaches or parent helpers.
Signature: ___________________________________________
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Swimmer registration (repeat this page for every swimmers registered)
Check the desired group (visit our web site for the groups description)
Evening civil groups
Pré-dév gr 1:
Pré-dév gr 2:
Pré-dév gr 3:
Pré-dév gr 4:
Dev 3:
Dev 2:
Dev 1 & GA:
GA élite:
Morning school and civil groups
Initiation:
Dev 3:
Dev 2:
Dev 1 et GA:
GA Élite:
Payment information
*** All check must be postdated and given at registration. Made out to Club de Natation Les Citadins
At registration: 100$ non refundable
October 1st 2014: Administration fees, nun refundable
November 1st 2014: Competition fees. See web site for policies on competition fees under Parent
December 1st 2014, February 1st and March 1st 2015, the balance split in three parts.
***See web site for fees, and details on schedule payments under Registration
Section reserved to the Club
100$ d’inscription :
No
Chèque
$
Frais d’administration :
No Chèque
$
/
/
Frais de compétition :
No Chèque
$
/
/
Solde :
No Chèque
$
/
/
No Chèque
$
/
/
No Chèque
$
/
/
No Chèque
$
/
/
No Chèque
$
/
/
Dépôt bénévolat :
/
Identification du nageur:
www.LesCitadinsNatation.com • www.facebook.com/LesCitadinsNatation • [email protected]
/
Politique de Confidentialité, d’accès à l’information et
protection
des renseignements personnels
FORMULAIRE DE CONSENTEMENT
Veuillez lire soigneusement, remplir et signer ce formulaire.
Un parent ou un tuteur légal doit signer pour les nageurs
qui ont moins de 18 ans.
Nom du club de natation : (le «club»)
Club de natation les Citadins
Nom complet du nageur : (le «nageur»)
_____________________________________________
Numéro d’inscription de Swimming Natation Canada :
______________ (numéro à 9 chiffres)
Tous les nageurs ou leur parent ou tuteur légal doivent signer
une copie de ce formulaire.
Je consens par la présente à la collecte et à l’utilisation de mon
information personnelle telles que décrites ci-dessus.
Ce formulaire sera conservé avec les dossiers du club mentionné cidessus jusqu’à ce que le consentement soit retiré ou que l’individu ou
la famille cesse d’être un membre de la Fédération de natation du
Québec.
En cas de transfert vers un autre club de la province, un nouveau
formulaire de consentement devra être complété et conservé dans les
dossiers de ce nouveau club.
Les individus « indépendants/unattached » doivent compléter et
envoyer ce formulaire de consentement directement à la Fédération de
natation du Québec.
____________________________________
Signature du nageur (si 18ans ou plus)
Date _______________
OU
____________________________________
Signature du parent ou tuteur (si 17ans ou moins)
Date _______________
____________________________
Nom en lettres moulées et lien avec le nageur (si signé par le tuteur)
Tél. (jour) (______)___________________________
Tél. (soir) (______)___________________________
Courriel : ___________________________________
Version 3 septembre 2010
Page 5
« Ce formulaire est extrait du document du même titre
pour fin de traduction. »
« Veuillez consulter le document avant de signer ce formulaire. »
Policy on the Confidentiality & Access to
Information and the
Protection of Personal Information
CONSENT FORM
Please read carefully, fill out and sign this form.
A parent or legal guardian must sign for swimmers
less than 18 years old.
Name of the swimming club : (the «club»)
Club de natation les Citadins
Swimmer’s full name : (the «swimmer»)
_____________________________________________
Swimming Natation Canada registration number :
______________ (9-digit number)
All swimmers or their parent or legal guardian must sign a
copy of this form.
By the present, I consent to the collection and use of my personal
information as described above.
This consent form will be kept in the files of the above-mentioned
club until such time as the consent is withdrawn or that the
individual or the family are no longer members of the Quebec
Swimming Federation.
In the case of a transfer to another club in the province, a new
consent form is to be completed and kept in the files of this new
club.
« Unattached » individuals must complete this consent form and
send it directly to the Quebec Swimming Federation.
____________________________________
Swimmer’s Signature (if 18yrs or older)
Date _______________
OR
____________________________________
Parent or Guardian’s Signature (if 17yrs or less)
Date_________________
_____________________________________________
Name (printed) and relationship to swimmer (if signed by guardian)
Tel. (day) (______) ____________________________
Tel. (eve.) (______) ___________________________
E-mail : ______________________________________
Version : Sept-3-10
English version of the FNQ’s « Formulaire de consentement » (page
5 of document « Politique de Confidentialité … »)
Please consult the said document before signing this form.