Name of swimmer *

First Name

Last Name

Date of birth: *

MM

DD

YYYY

Swimmer's phone (if applicable)

(###)

###

####

Swimmer's address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Which team is the applicant interested in? *

Fees noted are paid monthly.

Semi-Competitive (Intro to Competitive) (Birth years: 2015 - 2017) $222.11

Classic 10&Under (Birth years: 2015 - 2017) $333.22

Classic Novice 11+ (Birth years: 2012 - 2014) $333.22

Classic 11-12 (Birth years: 2013 - 2014) $521.33

Classic Youth (13 - 15) (Birth years: 2010 - 2012) $521.33

Classic Junior (15 - 19) (Birth years: 2009 or earlier) $521.33

National Youth (13 - 15) (Birth years: 2010 - 2012) $753.67

National Junior (15 - 19) (Birth years: 2006 - 2009) $852.89

Current club #1's phone number

(###)

###

####

Past club #2's phone number

(###)

###

####

Name of parent *

First Name

Last Name

Parent's phone *

(###)

###

####

Parent's address

If different than above

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Today's date *

MM

DD

YYYY

I authorize the verification of the information provided on this form

Authorization of parent (if under 18)

Authorization of applicant (if 18 or over)