WHAT: All eligible swimmers must achieve the Long
Course Zone Qualifying Time for each event the swimmer enters. A swimmer may
submit an application without having achieved the Qualifying Time with the
understanding that the application will only be accepted if there are one or
fewer qualified entrants to represent
WHEN August 10-13, 2005, Buffalo, NY
August 14, 2005 – Open Water Swim
WHO MAY APPLY: Any New Jersey/USA Swimming registered swimmer, who
has participated in a minimum of two NJ sanctioned swim meets in the
current Long Course season (May 1 to Long Course Junior Olympics), may
apply for consideration by completing this application. A swimmer is not eligible to compete in the Long
Course Zone Meet if he/she has competed in an individual event at a USA
Swimming National Championship, the US Open or a USA Swimming Trials Class Meet . The application is for consideration only. Please be
sure to list the NJ Sanctioned meets you have participated, within the current
year, on the attached application. Application will NOT be valid without
these meets listed.
WHERE: 12 & Under events will
be held at
HOTEL: Comfort Inn,
COST: $35.00 application fee (which must accompany your
application), and any additional costs. All fees are due and payable to NEW
JERSEY SWIMMING, Inc upon acceptance to the Zone Team.
If you wish to sign up for
the Open Water Event for August 14th, you must submit the open water
entry form and $20.00 payable to Star Swimming, Inc.
EQUIPMENT: Application fee will provide each swimmer with a cap
and 3 t-shirts. Bathing suits, shorts,
Zone Team Jacket and team bag at additional cost. Female suits $35.00 Male Jammers $28.00 Male Briefs 25.00 Shorts $13.00 drag suits $18.00 Jacket $47.00 and bag $35.00, New Parents polo shirt $18.00.
An adult must accompany a swimmer during the entire meet. Additional rules will be explained upon qualifying for the team.
Practice
times: To Be announced
Please mail your application
and $35.00 payable to: New Jersey Swimming, Inc, 1933 Rt 35 Ste 105 PMB 349 Wall, NJ 07719
ADDITIONAL INFO: http://www.pvswim.org/eastzone/future_meets.htm
Swimmers Full Name: Birth date:
City: St: Zip: Age (as of 08/10/05)
All necessary phone numbers: home work
Cell
E-Mail:
Parent/Guardian accompanying swimmer:
Emergency Contact: Phone:
Health Insurance Company (name, policy & phone numbers):
List the two sanctioned New Jersey Meets you have been a
participant in within the current Long Course season
1. 2.
List each individual event for which you have achieved the
qualifying time. Maximum of 3 events per day, 6 total
individual events.
Event
description Time
& Meet Consideration
1.
2.
3.
4.
5.
6.
Times for Relay Consideration Fly Back Breast Free
50
meters
100
meters
Include with your application Fee $35.00
payable to NJ Swimming Inc. Medical
Release Form Code Of
conduct Form Payment/Equipment Order Form
Name
Age Group
MEDICAL RELEASE FORM
Swimmers Full Name: Birth date:
Emergency Contact: Phone:
Health Insurance Company (name,
policy & phone numbers):
The chaperones, coaches and manger
of New Jersey Swimming may act in my behalf in the
event of an
accident to my child. I expect that I
will be contacted, but if I cannot be reached,
these
individuals may take such actions as is deemed necessary in line with medical
advise.
I am indicating here below of any special
medical problems, including any required medication(s) of my child, which
should be made known to the doctor or nurse.
I am indicating here below of any special
food allergies, requirements for my child,
which should be
know :
My child has no medical problems that you need to be aware of
My child has no food allergies/requirements that you need to be aware of
It is important that all medical
information be given to avoid problems of this type during the
Trip. THIS FORM IS NOT VALID UNLESS IT IS SIGNED BY
A PARENT OR GUARDIAN OF
THE SWIMMER LISTED ABOVE. This
form must be signed and properly filled out before the
swimmer departs
on the trip.
(date) (signature of Parent/Guardian)
(home phone) (work/cell phone)
If the swimmer’s parents will be
at the meet, please provide the phone number and name of the hotel where you
can be reached:
Name Age Group
New Jersey Swimming Zone Team Code of Conduct
As
a member of the Long Course New Jersey Zone Team I agree to the following:
1.
I will attend
all team meeting and functions to the best of my ability
2.
I will observe
the reasonable curfew set for me
3.
I will wear the
appropriate team uniforms
4.
I will conform
to all team rules and procedures as announced by team staff.
5.
I will compete
in ALL events to my best ability.
6.
I will be a good
representative of New Jersey Swimming
As
a member of the Long Course New Jersey Swimming Zone Team, I am aware that the
following are PROHIBITED:
1.
Use of alcoholic
beverages.
2.
Possession or
use of illegal drugs.
3.
Use or
possession of tobacco products.
4.
Inappropriate or
destructive behavior.
Persons
present while any of the prohibitive activities occur must leave immediately or
be considered a participant. You must
immediately contact your chaperone, or any New Jersey
Swimming Staff and notify them of the prohibitive behavior.
Conduct:
I
have read the CODE OF CONDUCT and rules above, and accept the conditions as
outlined:
(Athlete’s signature) (Parent/Guardian
Signature)