Ormoc Aquatic Edge Swimming Lesson Registration

Ormoc Aquatic Edge Triathlon School Registration

American Swimming Coaches Association Level 3
Participant Name*

First NameLast Name
Birthdate*

MonthDayYear
Date
Sex*
Age *
**Participants must be potty trained
- Participant Name (#2)
  
  First NameLast Name
- Birthdate
  
  MonthDayYear
  Date
- Sex
- Participant Name (#3)
  
  First NameLast Name
- Birthdate
  
  MonthDayYear
  Date
- Sex
- Parent/Guardian Name*
  
  First NameLast Name
- E-mail*
- Phone Number*
  
  Area CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry

Medical Information
YesNo
If yes, please explain
Photo Release

I authorrize my child to be photographed by a member of Ormoc Aquatic Edge and used for advertisement of said program on websites and/or printed materials.
Signature*

First NameLast Name

Ormoc Aquatic Edge Triathlon School Registration