Swim Registration Form

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This field is for validation purposes and should be left unchanged.

Contact Info

Name*

Address*

Phone*

Alternate Phone

Email*

Alternate Email

Membership Type

Primary Membership Type*

First Household Member - RESIDENT - $75

First Household Member - NON-RESIDENT - $160

Number of Additional RESIDENT Household Members ($20 Each)

Number of Additional NON-RESIDENT Household Members ($25 Each)

Total

Primary Member

Name*

Age*

Additional Family Member(s)

Name #1*

Age*

Relationship*

Name #2*

Age*

Relationship*

Name #3*

Age*

Relationship*

Name #4*

Age*

Relationship*

Name #5*

Age*

Relationship*

Name #6*

Age*

Relationship*

Additional Family Member(s)

Name #1*

Age*

Relationship*

Name #2*

Age*

Relationship*

Name #3

Age*

Relationship*

Name #4*

Age*

Relationship*

Name #5*

Age*

Relationship*

Name #6*

Age*

Parents/ Guardian must sign for a family member between the ages of 13 and 18 to attend the swimming program unaccompanied by an adult.

Name of Minor(s) - If not applicable, leave blank

Parents Signature*

Please type your name here

Emergency Contact Information

Name*

Phone*

Relationship*

Please list disabilities, allergies, and medical concerns for any family member:

Date*

Signature*

Swim Registration Form

Contact Info

Membership Type

Primary Member

Additional Family Member(s)

Additional Family Member(s)

Parents/ Guardian must sign for a family member between the ages of 13 and 18 to attend the swimming program unaccompanied by an adult.

Emergency Contact Information

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