AGCC WAHOOS Summer Swim Team
2019 Registration Form
Swimmer Information
(Please complete a separate form for each swimmer)
Swimmer's Name *
Your answer
Gender *
Swimmer's Date of Birth *
MM
/
DD
/
YYYY
Swimmer's Age (As of June 1st) *
Your answer
Medical/Health Problems/Allergies *
(If not applicable, please enter N/A or none)
Your answer
T-shirt Size *
Required
Suit Size (suits available for fitting at orientation)
Experience (select all that apply) *
Required
Parent/Guardian Information
Ayden Golf & Country Club Membership *
Required
Parent/Guardian Name(s) *
Your answer
Parent/Guardian Cell Phone # *
Your answer
Additional Parent/Guardian Cell Phone # *
Your answer
Parent/Guardian Email Address *
Your answer
Parent/Guardian Mailing Address *
(include street, city, state, and zip code)
Your answer
Emergency Contact Information
Emergency Contact Name *
(if parent not available)
Your answer
Relationship to Swimmer *
Your answer
Emergency Contact Phone # *
Your answer
Family Sponsorship Interest
($100 includes notation on team shirt and publications, as well as a free team shirt!)
Release of Liability
By electronically signing below, you, the parent/guardian of the swimmer, hereby releases AGCC, its employees, officers, directors, volunteers, and any facility used by AGCC from any liability arising out of any injury to the swimmer which may occur while the swimmer is participating in the AGCC swim program, including, but not limited to; practices, meets, travel trips, and other team activities, or while swimmer is using facilities owned, leased, or used by AGCC. *
Your answer
Date *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service