Swim Team Application

Swimmer Information

Child’s Name (Last, First) Sex Date of Birth Age on June 1st

_____________________________________ M F ________________ ______________

_____________________________________ M F ________________ ______________

_____________________________________ M F ________________ ______________

_____________________________________ M F ________________ ______________

Child’s School(s): __________________________________ Preferred Swim Stroke: __________________________________

Have you swum competitively before? _______ If so, where? ________________________________________________

Will you be swimming for another team this summer? _______ How many years have you been on a team ?__________

What are your expectations? _________________________________________________________________________________

Parent Information

Last Name: _____________________________________ First Name(s): _____________________________________________

________________________________________________ ____________________________________________

Address: ____________________________________________________________________________________________________

Phone No. _____________________ Work No. ___________________________ Email: _______________________________

Place(s) of Employment: ______________________________________________________________________________________

Name of person(s) other than parents to contact in case of Emergency:

1. _____________________________________________________ Phone No. _____________________________________
2. _____________________________________________________ Phone No. _____________________________________

Family physician: ___________________________________________ Phone No. _____________________________________

Information that would be useful in the event of an emergency (i.e. Allergies? Diabetes?):

_____________________________________________________________________________________________________________

Parental Consent Form

On behalf of myself and my child(ren), I certify that my child(ren) is/are in normal health and capable of participation in the swim program. I further understand that participation in the swim program involves risk and possible injury and represent to The Woods of St. Thomas Swim Club that my child(ren) has/have medical health insurance to cover any injuries sustained as a result of participation in the swim program. I authorize The Woods of St. Thomas Swim Team Staff to secure emergency medical treatment should my child require it.

Signature of Parent: ____________________________________________________ Date: _____________________________