[ Up ]                                STRATHMORE-BEL PRE DOLPHINS – 2006 REGISTRATION

Swimmer Information:  

 Name ___________________________________________________ M/F ____ Birth Date  ___/___/___
       [As you want it on trophies, records, etc.]

 Address ________________________________________________________________________________

 Parent/Guardian Information:

MOTHER/FEMALE GUARDIAN:                           FATHER/MALE GUARDIAN:

 Name ____________________________________ Name _____________________________________

 Address __________________________________ Address ___________________________________

 Tel.______________________________________  Tel.________________________________________

 E-mail ____________________________________ E-mail _____________________________________

 To which parent or guardian should swim team matters be addressed?

Mother/Female Guardian ________  Father/Male Guardian  ________ Either/Both __________

 Please explain any medical/personal information (i.e., medical conditions or medications, care) that coaches should
 know about?
_____________________________________________________________________________________

_____________________________________________________________________________________

Alternate Emergency Contact Information:

Name and phone number of person to contact in case of emergency when a parent or guardian cannot be reached:

Name:__________________________________________________________ Telephone:_________________________

Parent/Guardian Commitments:

I hereby express a willingness to help the swim team.  I understand that I may be asked to help set-up before and clean-up after
swim meets, help run the meets, drive to and from swim team functions, and in various other ways contribute my time and talents.

                                    ________________________________________

                                                Parent/Guardian Signature

I understand that I may be asked to drive to swim team functions and that if I cannot drive my child to a required function, I will
make arrangements with other drivers to accommodate my child.  I hereby grant permission for the child named above to be a
passenger in a private vehicle, driven by a licensed driver, to and from swim team functions and activities.

                                    ________________________________________

 FEES: 

First swimmer - $80;    Second swimmer - $60;    Each additional swimmer - $ 40  

Make check payable to: SBP Dolphins Parents' Club  

PAID $_______________DATE _____/_____/_____ RECEIVED BY ________________________