Please complete the following information to register in the Moving Up program at Cygnus Diving Club. Official registration is complete only when a completed form and payment has been received, and receipt of payment has been issued. Please allow several business days for your invoice to be sent. If you have any questions about registration please contact info@cygnusdiving.ca.

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Program Selection

Programs, schedule, and coaching are all subject to change. Minimum class sizes must be met to run a class. A child is not officially registered until Cygnus Diving Club has received a completed registration form, payment, and you've been issued receipt of payment from Cygnus.

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Diver Information

Name (First Last)*

Birthdate*

Gender*

Female

Male

Street Address*

City*

Province*

Postcode*

Primary Contact Email*

Secondary Contact Email

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Parent/Guardian/Emergency Contact

Parent/Guardian 1 Name (First Last)

Home Phone*

Cell Phone*

Parent/Guardian 2 Name (First Last)

Home Phone

Cell Phone

Primary Emergency Contact Name*

Relationship to Diver

Phone*

Secondary Emergency Contact Name

Relationship to Diver

Phone

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Medical Information

Health Card Number

Family Physician Name

Physician Phone Number

Medical Conditions*

Medications*

Allergies (if any)*

Photo Consent and Media Release Form

I/we hereby grant consent to Cygnus Diving Club and the Nova Scotia Amateur Diving Association (NSADA) to reproduce and/or use photos taken or obtained of the registered diver for use in the promotion of Cygnus Diving Club and NSADA.

I/we understand and agree that any and all photographs, recordings, films or reproductions may be used to promote the athletes, Cygnus Diving Club and NSADA.

I/we herby release Cygnus Diving Club and its officers, directors, agents and employees from any and all liability arising from the rights granted hereby and from the use of my/my child’s name and likeness as herein authorized.

I/we understand that reproduction and usage of my/my child’s image, name, likeness and/or written comments through any media come without compensation and are solely for the purpose of promoting the sport, Cygnus Diving Club, and NSADA.

I/we understand that the image or likeness of me/my child may appear in print materials (such as brochures, displays, posters, or advertising), or online (website and social media).

Checkbox Group*

I Consent

I DO NOT Consent

I am aware that accidents and injury are an inherent risk of diving and can happen without any fault on the part of the instructors/coaches, Cygnus Diving Club or Centennial Pool. By allowing the above named registrant to participate in this activity, I accept the risk of accident and injury and agree that the activity as described in the program information is suitable for the registrant.

I understand that for the safety and privacy of all participants, no photos or videos are permitted. If found in violation of this policy, I/my child/guardian may be asked to leave the facility.

Diver Name*

Parent/Guardian Name*

Cygnus Diving Club

Moving Up Registration

Program Selection

Diver Information

Parent/Guardian/Emergency Contact

Medical Information

Photo Consent and Media Release Form

A springboard and platform diving club in Halifax, NS.