PLPOA Porpoises Registration

PLPOA Porpoises

Swim Team
- Full Name*
  
  First NameLast Name
- Address*
  
  Street Address
  
  Street Address Line 2
  CityState / ProvincePostal / Zip Code
- Date of Birth*
  
  MonthDayYear
- MaleFemaleOther
- Please list any medical conditions, allergies, medications, or any other pertinent information about the participant. Type N/A if none.*
- Parent / Guardian #1*
  
  First NameLast Name
- Phone Number #1*
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Address #1*
  example@example.com
- Parent / Guardian #2
  
  First NameLast Name
- Phone Number #2
  Please enter a valid phone number.Format: (000) 000-0000.
- Email Address #2
  example@example.com
- Emergency Contact (Other Than Parents/Guardians)*
  
  First NameLast Name
- Relationship to Participant*
- Emergency Contact Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.

Do you plan on travelling to and competing in any swim meets?*
Swimmers must purchase a gear package if planning to compete in any travel meets!

Gear Package (Each swimmer must select one package!) We will be able to utilize a local company to purchase shirts and shorts, so the price has decreased from the price quoted at the meeting!

Womens Team Gear Package

Includes: Suit, Bag, Shirt, Shorts

$85.00 Quantity

Mens Team Gear Package

Includes: Jammer, Bag, Shirt, Shorts

$75.00 Quantity

Swim Cap with Logo

This item is optional!

$10.00 Quantity

Total

$0.00

Credit Card

- Swimsuit Size
- T-Shirt Size
- Shorts Size
Should be Empty: