Registration Form

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PLEASE COPY AND PASTE THIS FORM ON A WORD DOCUMENT AND PRINT OUT THIS FORM AND FILL IT OUT FOR THE APRIL 29 4:30-7:30 at Vista OR May 2 9am - 11am at Vista  REGISTRATION DAY

GENESEE SWIM TEAM   2010 REGISTRATION
 ONE SWIMMER
TWO SWIMMERS
THREE SWIMMERS
Registration Fee
(Includes Insurance)
$200

$200

$185

$200

$185

$175

Subtotal
$200
$385
$560
   
King Soopers Refill Card   
   

TOTAL

   
* Genesee Swim Team requires every family to purchase a  King Soopers refill CARD during the summer to help raise the funds for the team or make the equivalent donation of $20.   The team receives 5% of the value of the coupons (5% of $400 = $20). 

REGISTRANTS

Swimmer’s Name
Sex
M/F
Age on May 15th
Birth date
Address
Phone
Doctor/
Phone
Emergency
Contact
        
        
        

PARENT SIGN-UP - WE HAVE CHANGED THE FORMAT OF VOLUNTEERS, WE WILL WAIT UNTIL MEET ENTRIES ARE COMPLETE ON TUESDAYS AND ASSIGN JOBS TO PARENTS THAT HAVE KIDS SWIMMING UNLESS OTHER ARRANGEMENTS ARE MADE. 

Parent(s) Name: _______________________________Parent(s)  Name: ____________________________
Address: _____________________________________Address____________________________________
Phone Number:_______________________________ Phone Number_______________________________
 

Email (Print)_________________________________

Email Address_______________________________
 

Does your child have any Medications or Medical Conditions you would like to have the coaches aware of?  If so, please explain:_________________________________________________________________________________