Name:________________________ Address:_______________________ City___________ State__Zip_____

Phone:__________ Date of Birth:_____ Age:

Please describe your swimming background:

__YMCA __ Yrs.; _ USS __ Yrs.; _ Summer Only __ Yrs.

Emergency Contact:______________________

Medical conditions/ Allergies:___________________________________

_____________________________________________________________

Mother:__________________ Father:______________________

Parent's experience with swim club/team work (Officials, timers, etc.)_________________________________________________________

Parent's preferred volunteer committees:

Meets         Fundraising         Chaperone         Officials         Banquet