Swimmer's Information
First Name:
M:
Last:
Age:
Swimmer's Birthday:
M or F:
Grade and School:
First Name:
M:
Last:
Age:
Swimmer's Birthday:
M or F:
Grade and School:
First Name:
M:
Last:
Age:
Swimmer's Birthday:
M or F:
Grade and School:
First Name:
M:
Last:
Age:
Swimmer's Birthday:
M or F:
Grade and School:
Father's Name
Mother's Name
Home Phone
Home Phone
Father's Cell Phone
Mother's Cell Phone
Father's Work Phone
Mother's Work Phone
E-mail Address
E-mail Address
Swimmer's Mailing Address:
City:
State:
Zip:
Allergies and/or Special Medical Problems
Swimmer #1
Swimmer #2
Swimmer #3
Swimmer #4
Emergency contacts if we are unable to reach parents:
Name 1
Phone Number
Name 2
Phone Number
Additional Comments