ARLINGTON SWIM TEAM REGISTRATION FORM
Swimmer
Information:
1st
Swimmer Name: ________________________ M
F (circle one)
Birth Date:
___/___/___ Age as of June 1st
____________
Address:
_________________________________________
City:
_____________ State: _________ Zip:_______
Allergies:
_________________________________ Asthma: Yes/No
Any additional
medical issues: _______________________________
2nd
Swimmer Name: ________________________ M
F (circle one)
Birth Date:
___/___/___ Age as of June 1st
_____________
Allergies:
__________________________________Asthma: Yes/No
Any additional
medical issues: _______________________________
3rd
Swimmer Name: _________________________ M
F (circle one)
Birth Date:
___/___/___ Age as of June 1st
______________
Allergies:
_________________________________ Asthma: Yes/No
Any additional
medical issues: _______________________________
Parent/Guardian/Sitter
Information:
Mother:
___________________ Phone: _________
Work: _______
Cell:
_________________ Email: ___________________________
Father:
________________ Phone: __________
Work: ________
Cell:
__________________ Email:
__________________________
Guardian or
Sitter: ________________ Phone: _________________
Cell:
__________________ Email: ___________________________
Emergency
Contact(Other than parent, guardian or sitter):
Name:
_____________ Relationship to child: ___________________
Phone:
____________ Cell: ________________ Work: ___________
Vacation
Dates:
___________________________________________