Potential Swimmer Form
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Email *
Phone Number *
Swimmer's Last Name *
Swimmer's First Name *
Parent's Last Name *
Parent's First Name *
Swimmer's Age *
Swimmer's Date of Birth *
MM
/
DD
/
YYYY
Swimmer's Experience Level - Enter the highest number achieved below:
0 = Can NOT do all four competitive strokes legally
1 = Can do all four competitive strokes legally but never in competition
2 = Have competed in HOA / City Swim Meets
3 = Has competed in USA Swimming Competitions
 *
A copy of your responses will be emailed to the address you provided.
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