Registration

Fields marked with * are required.

1. Your account information

First Name*
Last Name*
Email Address*
Password*
Password Confirmation*
Address*
City*
State*

2. Your swimmers

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First Name*

Last Name*

Sex*

Age*

Birth Date* / /

3. Swimmer information

Parents Names*
Home Phone

Dad's Phone

Mom's Phone

4. Emergency contact information

Emergency Contact 1*

Phone*

Relationship*
Emergency Contact 2*

Phone*

Relationship*

Medical Insurance Provider*
Group Number*
Plan Participant Name*
Hospital of Choice*
Does your child have any physical problems of which we should be aware?

If your swimmer is going to be gone during the season, please list the dates, specifically marking the swim meet dates he/she will miss.
Monday June 6th - @ Wilchester
Thursday June 9th - Plaza Oaks @ Home
Monday June 13th - Memorial Bend @ Home
Thursday June 16th - @ Spring Branch
Monday June 20th - Memorial Forest @ Home