Water Polo Registration
Swimmer's First Name *
Middle Name
Last Name *
Birth Date *
MM
/
DD
/
YYYY
Age *
Grade *
Gender *
Address *
City *
State *
Zip Code *
Parent's First Name *
Parent's Last Name *
Cell Phone *
Home Phone
Other Phone
Email *
T-Shirt Size *
Lake Highland Student *
Emergency Contact *
Emergency Contract's Phone *
Session *
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This form was created inside of Lake Highland Preparatory School.