Registration Form by q2ENdC71


									   2010-2011 Learn to Swim / Prep-Team Program Registration

     Participant’s Name:                                                                      DOB:

     Home Address:

     City:                                             State:                        Zip:

     Parent/Guardian Names:

     Cell Phone                                                           Home Phone

     Family E-mail Address

     Name of School
     T-shirt Size (Circle One)

     Youth Small                    Youth Medium       Youth Large             Youth XL

     Adult Small                    Adult Medium       Adult Large             Adult XL

               Reg Form          Liability   Reg Fee       Dues      T-shirt    Level     Schedule

     Registration Fee: $25.00 for year
     Learn to Swim Prep Team Fees: $50.00 per month

Golden Isles Swimming, Inc. PO Box 1096 Brunswick, GA 31521
             Golden Isles Swimming, Inc. is a not for profit 501(c)(3) corporation.

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