Please complete this form and submit it.  The coach will contact you to comfirm the appropriate swim group for your
child and to discuss costs and the practice schedule.  
Swim Group:
(choose the group that most closely matches your child's qualifications)
Parent Name:
(first and last)
Address 1:
Address 2:
City, St, Zip:
Home Phone:
 Cell Phone:
Work Phone:
 email address:
Swimmer's Name:
(first and last)
Swimmer's Age:
Gender:
Swimmer's
Date of Birth:
Comments: