Fairfield-Fairfield Crest Swim Club
2019 MEMBERSHIP APPLICATION & MEDICAL FORM
LAST NAME(S) OF ADULT MEMBER(S): *
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FIRST NAME(S) OF ADULT MEMBER(S): *
Please list only those adults included on your Bond/Certificate. Do not list dependent children or parents here.
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STREET ADDRESS: *
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CITY, STATE AND ZIP CODE *
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PRIMARY PHONE NUMBER *
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SECONDARY PHONE NUMBER
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EMAIL ADDRESS- primary *
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EMAIL ADDRESS- secondary
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OCCUPATION(S):
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HOBBIES:
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