CENTRAL VALLEY ROWING CLUB, INC.

4950 Buckley Cove Way

Stockton, CA 95219
centralvalleyrowingclub@gmail.com
(209) 400- 2ROW

REGISTRATION FORM
This form must be completed with payment included in order to be eligible to row
JUNIOR INFORMATION: Please print
Name: Last:_____________________________________ First:______________________________________
Address:________________________________________ Home Phone:_______________________________
City:________________________ Zip Code:___________ Cell Phone:_________________________________
Date of Birth:_________________ Age:_______________ Grade Level:_______ School:__________________
Height:______________________ Weight:____________

PARENT/GUARDIAN INFORMATION:
Parent(s)/Guardian(s) Name:__________________________________________________________________
Cell Phone:______________________________________ Work Phone:_______________________________
Home Phone:_____________________________________
Parent(s)/Guardian(s) Address (if different from above):____________________________________________
__________________________________________________________________________________________

Parent(s)/Guardians(s) Email Address:___________________________________________________________

Athletes Email Address (if any):________________________________________________________________

CENTRAL VALLEY ROWING CLUB, INC.

CODE OF CONDUCT
The following team rules are a supplement to US Rowing, SWJRA and SIF policies, regulations and procedures.
Each team member should read, understand and follow each of the policies, regulations and procedures,
during the entire 10 month rowing season and academic year.
The following items apply to all Central Valley Rowing Club Athletes during CVRC events, practices, races,
functions, etc. Failure to comply with any of these guidelines may result in suspension or termination from
CVRC.

First and foremost, remember that you are representing the club whenever you are involved with ANY
CVRC activity. If you wouldnt do it in front of your coach or parents, dont do it in public as a
representative of this club.
Respect the CVRC boathouse facilities and keep clean (pick up after yourself, i.e., water bottles, socks
and misc. clothing. All items left will be put in lost and found. Lost & found will be cleaned out monthly
and all items donated to Goodwill.)
Be courteous and respectful to other teammates, opponents and coaching staff.
Be respectful to all Riverpoint Marina patrons (the marina is a multi-use facility and may have many
activities running at the same time, please be mindful of other patrons.)
Represent you team with pride at all times
No swearing or inappropriate gestures
Physical assault of any type is prohibited
Respect others personal property
Weapons or firearms are prohibited
Boyfriend-girlfriend relationships are to be left at home. They will not be tolerated at CVRC team
functions i.e., practice, regattas, meeting, etc.
Horse play in the boathouse or marina, or in/on vehicles is prohibited
Abuse of equipment will not be tolerated
Report all broken equipment to coaching staff ASAP
Athletes only have use of the facility during scheduled practice times
When at away regattas/events, leave everything in a condition in which you found it. Dont leave a
mess anywhere (at a rowing venue, on a plane, in a hotel room, etc.)

I _____________________________________ hereby understand the terms explained above and by signing
this form I will abide by this code of conduct.
Signature _____________________________________________________ Date _______________________
(Athlete)
Signature _____________________________________________________ Date _______________________
(Parent)


CENTRAL VALLEY ROWING CLUB, INC.

MEDICAL RELEASE FORM

MEDICAL/EMERGENCY CONSENT AND INFORMATION

Consent for medical treatment: As the parents or guardians of the below named rower, I hereby give my
consent for emergency medical treatment, as prescribed by a duly licensed doctor of medicine or doctor of
dentistry. This care may be given under whatever conditions necessary to preserve life, limb, or well being
of my dependent child.

Rower information: Please Print
Last Name:__________________________________

First:______________________________________

Date of Birth:________________________________

Whom to notify in case of emergency:

Phone:____________________________________

Parent(s)/Guardian(s):_______________________________________ Phone:__________________________
Physician:_________________________________________________ Phone:__________________________
Insurance:_____________________________ Policy No.:_____________________ Grp No.:_______________
Dentist:___________________________________________________ Phone:__________________________
Insurance Carrier:___________________________________________ Policy No.:_______________________
Allergies:__________________________________________________________________________________
Medications:_______________________________________________________________________________
Limitations:________________________________________________________________________________

Please list the name and phone number of whom we may reach in case of emergency (other than parents):
1)_______________________________________________ Phone:__________________________________

_________________________________________ _________ ___________________________________
Signature of Parent/Guardian (if rower under 18)

Date

Print Name

CENTRAL VALLEY ROWING CLUB, INC.

PHOTOGRAPHIC, VISUAL, AUDIO, IMAGE RELEASE
This agreement is given in consideration of my own or my childs photograph, image and or audio of said personal likeness being
taken and possibly published on Internet, Websites, Broadcasts, and other publications as released to or by Central Valley Rowing
Club, Inc.

Warning and Assumption of Risk:
I understand that there are inherent risks associated with publications of my own or my childs photograph, audio and image of
personal likeness on the Internet, in videos and in publications. These risks may include but not be limited to identify theft and
wrongful assumption by others of my or my childs identify or who I or my child is and or danger to myself or my child.
I agree to assume these risks, whether known or unknown to me of permitting publications of my own or my childs photograph,
image of personal likeness and or personal audio on the internet, in publications or in videos.

Grant of Permission to Take Photographs, Images and Personal Audio:
I grant permission to Central Valley Rowing Club, Inc., and their employees and agents to take and use photographs, and
visual/audio images of myself or my child for any legal purpose. Visual/audio images include any type of recording, including but not
limited to photographs, digital images, drawings, renderings, voices, sounds, video recording, audio clips or accompanying written
descriptions. I grant this with the understanding that Central Valley Rowing Club, Inc., will not materially alter the original images. In
accordance with this grant, I also waive my and my childs rights to inspect or approve finished images or electronic matter prior to
publication and waive compensation for their use.

Release:
On behalf of myself, my child and our heirs, I hereby waive, release and discharge any and all claims of damages for death, bodily
injury, personal injury or property damage which I or my child may sustain, or which hereafter accrue to me or my child, against
Central Valley Rowing Club, Inc., as a result of my own or their own personal photograph(s), image of personal likeness or personal
video/audio being published except for those liabilities, claims and costs arising from the sole active negligence of the above stated
entity. This release is intended to discharge Central Valley Rowing Club, Inc., their officers, employees and volunteers, from and
against any and all liability arising out of or connected in any way with publication of my own or my childs photograph(s), images of
personal likeness, or personal audio/video, except for the related sole active negligence of these entities. It is further understood
and agreed that this waiver, release and assumption of risk is entered upon behalf of my child and myself and shall be binding on my
and their heirs and assigns.

Acknowledgement and Agreement
I acknowledge that I have been fully informed of the risks and dangers involved in photographic publication of my own or my childs
photograph, images of my/their personal likeness and video/audio.
I acknowledge that I have read, agree, and fully understand the above Warning, Waiver, Assumption of Risk and Release of Liability.

PARTICIPANT NAME (Print): _________________________________________________________________________________
SIGNATURE (if 18 years old or older): _____________________________________________ Date: ________________________
NAME OF PARENT OR LEGAL GUARDIAN: _______________________________________________________________________
SIGNATURE OF PARENT/LEGAL GUARDIAN: ________________________________________ Date: _________________________
Participants Address:_________________________________________ City: ________________________ State: ___________
Email:_________________________________________ Phone: __________________________________________________
(Parent or legal guardian must sign for all persons under the age of 18. Proof of age my be required.)

CENTRAL VALLEY ROWING CLUB, INC.

4950 Buckley Cove Way
Stockton, CA 95219
centralvalleyrowingclub.org

REGISTRATION FORM

This form must be completed and signed with payment included to be eligible to row


JUNIOR INFORMATION: Please print

Name: Last: ______________________________________ First: ___________________________________

Address: _________________________________________ Home Phone: ____________________________

City: _________________________ Zip Code: ___________ Cell Phone: ______________________________

Date of Birth: _______________ Age: ________________ Grade Level: _______ School: _________________

Height: ____________________ Weight ___________________

Texting Number: _____________________________ (in case practice gets cancelled or last minute race info.)


PARENT INFORMATION:

Fathers Name: ___________________________________________ Work Phone: _____________________

Employer: _______________________________________________ Cell Phone: _______________________

Mothers Name: __________________________________________ Work Phone: _____________________

Mothers Employer: _______________________________________ Cell Phone: ______________________

Parent(s) Address (if different from above): ______________________________________________________

Parent(s) Email Address: _____________________________________________________________________

Signature__________________________________________________________ Date:___________________

CENTRAL VALLEY ROWING CLUB, INC.

SWIMMING COMPETENCE CERTIFICATION
Junior Parents/Guardians & Participant
The sport of rowing poses significant risks to the participant because most activities occur in, on, or around
water. These risks include, but are not limited to, expected and unexpected immersion into cold water as a
result of a boat flipping, collisions with other boats, being involuntarily removed from a boat as a result of an
oars momentum (crabbing), falling off docks, authorized and unauthorized swimming, changing weather
conditions, or other occurrences.
Although all practices and regattas are supervised, from time to time a boat may be temporarily out of coachs
line of sight due to several factors which include, but not limited to the irregular shoreline of delta, race day
procedures or other conditions. Intended or accidental immersion into cold water can occur at any time.
Participants must be competent swimmers for their safety.
I certify that my child is a competent swimmer.
Junior Participants Name: __________________________________________________________________
Parent/Guardian Signature: __________________________________________ Date: _________________

ZERO TOLERANCE DRUG AND ALCOHOL POLICY

Central Valley Rowing Club, Inc. (CVRC), has adopted a zero tolerance drug and alcohol policy. The taking of
illegal drugs and the consumption of alcohol by those under the age of 21, are illegal acts. Any member of the
CVRC who is found to have acquired, used, or possess any alcohol or any illegal substance, at any practice,
regatta, or any club activity, will take responsibility for their actions. This may include suspension or
termination from the club.
A suspension for violation of this policy shall be effective for a minimum of six (6) months. In the event of a
suspension or termination as a result of this policy, the affected athlete and his/her parents or legal guardians,
are not entitled to any refund of the program fees, regardless of the date of suspension or termination.
As a member of the Central Valley Rowing Club, Inc., I have read and understand the above policy.

Junior Member Signature: ________________________________________ Date: _____________________
As a parent or guardian of the above named Junior, I have read and understand the above policy. I will ensure
that ANY social function involving the Central Valley Rowing Club, Inc., held in my home, or hosted by me at
another location will abide by the ZERO TOLERANCE DRUG and ALCOHOL POLICY.

Parent/Guardian Signature: ______________________________________ Date: _____________________