Swim Team Registration

Athlete Information
Athlete Name*
First Last
Gender*
- Male
- Female
Athlete Date of Birth*
Date Format: MM slash DD slash YYYY
USA Water Polo ID#
Athlete Cell Phone Number
Athlete Email
t-Shirt Size
Male Suit Size
Female Suit Size
Medical Conditions
Parent 1 Information
Parent 1*
First Last
Parent 1 Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Parent 1 Email*
Parent 1 Cell Phone Number*
Parent 2 Information
Parent 2
First Last
Parent 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Parent 2 Email
Parent 2 Cell Phone Number
Comments
Swimming $85/month*
Price: $85.00
Registration Fee
Price: $20.00
Todays Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Athlete Information