| Attached are my swim team fees in the amount of $__________ for the 2001 season (year). |
| Swimmer 1 ______________________ Date of Birth __/__/__ M__/F__ |
 Full Name Age as of 6/20/01 ______ |
| Swimmer 2 ______________________ Date of Birth __/__/__ M__/F__ |
| Full Name Age as of 6/20/01 ______ |
| Swimmer 3 ______________________ Date of Birth __/__/__ M__/F__ |
| Full Name Age as of 6/20/01 ______ |
| Swimmer 4 ______________________ Date of Birth __/__/__ M__/F__ |
| Full Name Age as of 6/20/01 ______ |
| Parent/Pool Member Names: _____________________________ |
| Address: _____________________________________ |
| City: _________________ Zip Code: ___________ |
| Email Address: _______________________________ |
| Home Phone: _________________ Work Phone: _________________ |
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| Emergency Contact: ____________________________ Phone: ___________ |
| Relationship: ____________________ |
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| In case an emergency situation arises and the parent/guardian in not present, either at practice sessions or during swim meet competition, parental signature on this application will permit emergency treatment of the swimmer by qualified pool staff until medical help arrives. |
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| Signature of Parent/Guardian: ___________________________ |
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| I/we are interested in supporting the team during home swim meets by volunteering my/our services in any of the following: |
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| Timer _______ Lane Judge _______ Concessions _______ Ribbon Writer ______ |
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| Please remember some of the positions may have been filled prior to receipt of your application, so number your preferences #1 through #4. |
