WAYNE DOLPHINS SWIM

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					                                                                                                             Office Use Only
                                              Wayne Dolphins Swim Club
                                                                                                           PAID_____________
                                                   Registration Form
                                        Fall 2011 (September 19-November 18)                               CASH ____________
                                                          www.waynerecdolphins.org
                                                                                                           CHECK___________
                                          All Dates are Tentative and are subject to change
                                                                                                           OTHER___________
                                Returning swimmers may mail in their Early Registration to:
                            Amy Cizauskas, 39234 Avondale St., Westland, Michigan 48186.
                      All new swimmers must try-out and register at the pool the first week of practice.
                      Fill out one Club registration form per family and one AAU form per swimmer.
                                         Everyone needs a new AAU form.
                                 Make checks Payable to: Wayne Dolphin Swim Club.
                                                         Fees:
                                 Early registration:    (Before September 19) $80
                                 Regular registration: (September 19 - 30) $85 AAU is included in this price!
                                 Late registration:    (October 1 – 7 ) $100
                                For each additional swimmer in your family you may subtract $5
                                        Tryouts will be held the first week of practice.
                                                 See schedule for specific times
                   * ALL Swimmers MUST participate in the marathon swim (a mandatory fundraiser)
                                     A minimum of $30 per swimmer or $50 per family
               SWIMMERS MUST BE PAID AND AAU REGISTERED BEFORE THEY BEGIN SWIMMING
     AGE         NAME                                                BIRTHDAY          Returning Swimmer   New Swimmer
     1._____     ____________________________________________       ___/___/___            __________       __________

     2._____     ____________________________________________       ___/___/___           __________        __________

     3._____     ____________________________________________       ___/___/___           __________        __________

 ADDRESS:___________________________________________________City:______________________Zip:______________

 PHONE (       )___________________________SCHOOL_________________________________________________________

 PARENT NAME:_____________________________________PARENT SIGNATURE:________________________________

 EMERGENCY CONTACT____________________________________EMERGENCY PHONE_________________________

 E-MAIL ADDRESS__________________________________________________________________

 ANY MEDICAL OR OTHER INFORMATION THE COACHS SHOULD KNOW ABOUT:
____________________________________________________________________________________

PARENT/VOLUNTEER DISCLAIMER
I/we the undersigned waive and release any and all claims against the Wayne Dolphin Swim Club, Wayne-Westland Community Schools,
Coaches of the Wayne Dolphin Swim Club, and the Officers of the Wayne Dolphin Swim Club.

    Signature__________________________________________________Date________________________

    Signature__________________________________________________Date________________________

    I AGREE TO HELP AT ONE VOLUNTEER JOB THIS SESSION! SIGNATURE________________________________________

    Swimmers Name/Names as you want it to appear on a trophy (please print clearly):

    _____________________________________________________          _______________________________________________

    ____________________________________________                  _______________________________________

				
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posted:4/20/2012
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