To print this page properly - use Print icon located on the page.
Please note that JavaScript has to be enabled.
 

2010-2011 Season Swimmer Registration Application

Level
Member ($75.00 (USD)) Subscription period: 1 year Automatic renewal: no

Fill in application form

Application form

* Mandatory fields
 

 

*Swimmer's Last Name
*Swimmer's First Name
*Birthdate
*Swimmer's School
*T-Shirt Size
*Parent/Guardian Last Name
*Parent/Guardian First Name
2nd Swimmer Last Name
2nd Swimmer First Name
2nd Swimmer's Birthdate
2nd Swimmer's School
2nd Swimmer's T-Shirt Size
3rd Swimmer Last Name
3rd Swimmer First Name
3rd Swimmer's Birthdate
3rd Swimmer's School
3rd Swimmer's T-Shirt Size
Home Phone
Cell Phone
*E-mail me HERE
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Cell
Special Medical/Allergies
*Create Your Password
 
 

Contact data

*Mailing Address
*City, State
*Zip code
*e-Mail at Work
Additional e-Mails
*Preferred e-Mail(s) for team phonebook/directory.
*Work Phone
Additional Phones
*Preferred phone for the team phonebook/directory.

Security check

* Code
 
Type the 6 characters you see in the picture
Captcha code image
Hear the code Try another code
Cancel
 
Updated:  Sept 6, 2010

More more information send an eMail to: 
info@kingfishswimteam.com

2010/2011 Kingfish Swim Team