Online Registration Form

Registration for Summer 2022

* Indicates required field

Parents Name: *

Parents Name 2 *

Address *

Emergency Contact Number *

Parents Cell *

Parents Cell (2) *

Parents Email *

Parents Email (2) *

Dates Swimmer is NOT Available *

Swimmer's Name *

First

Last

Gender *

Male Female

Swimmer's DOB *

Age 6/1/22 *

Swimmer's Name *

First

Last

Gender *

Male Female

Swimmer's DOB *

Age 6/1/22 *

Swimmer's Name *

First

Last

Gender *

Male Female

Swimmer's DOB *

Age 6/1/22 *

Medical Release Information:

Primary Medical Insurance Name: *

Policy Number: *

Preferred Hospital: *

Known Allergies or Other Pertinent Medical Information: *

SWIMMERS WILL BE IN THE POOL BEGINNING MAY 9, 2022. PRACTICE SCHEDULES WILL BE PROVIDED ONCE REGISTRATION IS COMPLETE.

REGISTRATION FEE IS $250 PER SWIMMER.
ADDITIONAL SWIMMERS IN THE SAME FAMILY ARE $230 EACH.

PLEASE MAKE CHECKS PAYABLE TO:
TROJAN AQUATIC CLUB
C/O R. SCARPATO
1109 SMALLBROOK LANE
YORK, PA 17403

By submitting this form, I give my permission for my child to participate in the Trojan Aquatic Club. I will not hold the aquatic club, York Suburban School District or the coaching staff responsible for any injury while participating in the program. I also give permission for my child to be treated by emergency personnel in the event of an injury if I am not present.

Submit Registration

Participation and Consent Forms