2022 Fall Swim Clinic

Swimmer Information
Swimmer 1 Name*

First NameLast Name
Swimmer 1 Date of Birth*

MonthDayYear
Swimmer 1 Age Group*
Age Group is determined by the age of the swimmer on May 15th
Swimmer 2 Name

First NameLast Name
Swimmer 2 Date of Birth

MonthDayYear
Swimmer 2 Age Group
Age Group is determined by the age of the swimmer on May 15th
Swimmer 3 Name

First NameLast Name
Swimmer 3 Date of Birth

MonthDayYear
Swimmer 3 Age Group
Age Group is determined by the age of the swimmer on May 15th
Swimmer 4 Name

First NameLast Name
Swimmer 4 Date of Birth

MonthDayYear
Swimmer 4 Age Group
Age Group is determined by the age of the swimmer on May 15th

Agreements
Tap on each section header (button) to reveal the corresponding agreement. Use the scroll bars to review each of the agreements and check the box to agree to each item. Each agreement must be accepted to complete registration. NOTE: You must scroll through the agreement to be able to select the chekbox.

Emergency Consent
This information will help us care for your child in the event of a medical emergency. This form presumes that each registered swimmer shares the same health insurance and medical providers. If this is not accurate for your family, please complete and print this form for each swimmer.
Emergency Contact Name*
Emergency Contact Phone*
Physical or Medical Concerns*

None of our swimmers have any physical or medical concerns.At least one of our swimmers has medication or other allergies; takes medication regularly; or has other medical concerns (details below).
Description: *
Should be Empty:

2023 Spring Swim Clinic