SNC - Competitive Swimmer Pre-registration Form

Swimmer:

First    Last

Swim Level:

eg. Novice, Junior, Age Group, Senior

Birthdate: mm/dd/yy

Address:

Postal Code:

Phone Number:

Cell Number:

Email:

Mother:

First    Last

Mother's Phone Number
(if different from above):

Father:

First    Last

Father's Phone Number
(if different from above):

Care Card:

Doctor:

Dentist:

Allergies and/or medications using:

Alternate Contact:

Alternate Phone Number:

Comments:

MEDICAL RELEASE FORM

I authorize Kamloops Aquatic Club personnel to provide or arrange for the provision of first aid or emergency treatment to my child in the event of an accident, injury, or illness and give permission for additional medical attention to be sought should the need arise.
This authorization is effective commencing on the 1st day of September 2009 and expiring on the 31st day of August 2010.

  

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