Swim Camp Registration Form

Swim Camp with Rick Powers

27 Feb - 04 March 2023
REGISTRATION FORM
Athlete's Name

First NameLast Name
Birth Date

MonthDayYear
Gender

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Information
Name

First NameLast Name
Home Number
Cell Number
E-mail
example@example.com
Emergency Information
Emergency Contact's Name

First NameLast Name
Relationship
Phone Number
Alt. Phone Number
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Signature

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Banking Details:
Bank name: Standard Bank
Branch code: 082672
Account holder: VEG CONSULTING AND INVESTMENTS CC
Account number: 6000 0259 534
Account type: CURRENT
Should be Empty:

Swim Camp with Rick Powers