xRegistration-W21-22

Registration for Winter 2021 - 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 12/1/21 *

Swimmer's Name *

First

Last

Gender *

Male Female

Swimmer's DOB *

Age 12/1/21 *

Swimmer's Name *

First

Last

Gender *

Male Female

Swimmer's DOB *

Age 12/1/21 *

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 OCTOBER 18, 2021. PRACTICE SCHEDULES WILL BE PROVIDED ONCE REGISTRATION IS COMPLETE.

REGISTRATION FEE IS $250 PER SWIMMER. 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

signature forms