www.LesCitadinsNatation.com • www.facebook.com

Swimmer identification
Name:
First name :
Birth date (AA/MM/JJ):
Citizen card No (Grants) :
Email:
Address:
Municipality:
Postal code:
School:
School board:
School level:
Check the size of the T-Shirt (the sizes are not guaranteed)
Youth medium:
Adult small:
Adult medium:
Adult large:
Parent identification
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:
Swimmer registration
Check the desired group (visit our web site for the groups description)
Evening civil groups
Initiation pm:
Pré-dév gr 1 pm:
Pré-dév gr 2 pm:
Dev 3 pm:
Dev 2 pm::
Dev 1 pm:
GA pm:
Élite pm:
Morning school and civil groups
Initiation midi:
Dev 3 am:
Dev 2 am:
Dev 1 am:
GA am:
Élite am:
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Mandatory volunteering
A $ 50 check post-dated to June 1st per family is requested at registration time as deposit for volunteering. To recover the $ 50,the family must have
accumulated 12 points by participating in the following activities:
Volunteer, Timekeeper for 2 points
Other official position for 3 points
Follow or offer a clinic for 6 points
A $50 check dated to September 15th is requested at registration time. To recover your check, you mest attend to the parent’s meeting at the beginning of
the year
Signature: ___________________________________________
Consent to be photographed
I consent that my children will be photographed and I authorize Le Club de Natation Les Citadins and the school program to use the pictures of my children
in promotion documents such as newspaper articles, local publicity, on the web site and on Facebook
Signature: ___________________________________________
Transportation consent
By signing this form, I allow my children to be part of the swimming activities of Le Club de Natation Les Citadins and if necessary, I authorize him/her to
travel in a vehicle driven by coaches or parent helpers.
Signature: ___________________________________________
Payment information
*** All check must be postdated and given at registration. Made out to Club de Natation Les Citadins
At registration: 270$ non refundable
October 1st 2016: Competition fees. See web site for policies on competition fees under Parent
November 1st, December 1st and February 1st 2017: the balance split in three parts.Parent
***See web site for fees, and details on schedule payments under Registration
June 1st 2016: Volunteering deposit if applicable to the group.See web site for volunteering policies under Parents
September 15th: Parent meeting deposit
Section reserved to the Club
270$ administration :
No Check
$
Competition fees:
No Check
$
Balance :
No Check
$
No Check
$
No Check
$
No Check
$
Parent meeting deposit:
No Check
$
Volunteering deposit :
No Check
$
Swimmer identification:
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Medical file of the swimmer
First name:
Name:
Medical card No:
Expiration date:
Medical profile:
Medications:
Allergies (specify):
Epipen (Yes/No):
Past serious injuries:
The swimmer can administer its own medicine (Yes/No):
Other: (prostheses, contact lenses etc...) :
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)
parents
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: ___________________________________________
Return forms and full payment to:
Club de natation les Citadins
2106 de la Falaise
St-Lazare, Qc, J7T 3B4
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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»)
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»)
_____________________________________________
_____________________________________________
Numéro d’inscription de Swimming Natation Canada :
Swimming Natation Canada registration number :
______________ (numéro à 9 chiffres)
______________ (9-digit number)
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 ci-dessus
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. »
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.