2022 Swim Team Registration Form

Parent Information

Parent 1 Name*

First Last

Parent 1 Phone*

Parent 1 Email (This is how all important swim team information will be communicated):*

Parent 2 Name

First Last

Parent 2 Phone

Parent 2 Email

Child 1 Information

Child 1 Name*

First Middle Last

Child 1 DOB (MM/DD/YYYY)*

Child 1 Age as of 6/1/2022*

Child 1 Gender*

Child 1: Please list any allergies or medical conditions that may be helpful for our staff to be aware of:

Child 1 T-Shirt Size*

Child 1 Shorts Size*

Child 1 Pants Size*

Child 2 Information (If needed)

Child 2 Name

First Middle Last

Child 2 DOB (MM/DD/YYYY)

Child 2 Age as of 6/1/2022

Child 2 Gender

Child 2: Please list any allergies or medical conditions that may be helpful for our staff to be aware of:

Child 2 T-Shirt Size

Child 2 Shorts Size

Child 2 Pants Size

Child 3 Information (If needed)

Child 3 Name

First Middle Last

Child 3 DOB (MM/DD/YYYY)

Child 3 Age as of 6/1/2022

Child 3 Gender

Child 3: Please list any allergies or medical conditions that may be helpful for our staff to be aware of:

Child 3 T-Shirt Size

Child 3 Shorts Size

Child 3 Pants Size

Child 4 Information (If needed)

Child 4 Name

First Middle Last

Child 4 DOB (MM/DD/YYYY)

Child 4 Age as of 6/1/2022

Child 4 Gender

Child 4: Please list any allergies or medical conditions that may be helpful for our staff to be aware of:

Child 4 T-Shirt Size

Child 4 Shorts Size

Child 4 Pants Size

Liability Waiver (please select and sign)

Liability Waiver*

I, the parent or guardian of the applicant, hereby give my permission for my child(ren) to participate in the Carlisle Swim Club Swim Team and Capital Area Swim League (CASL) during the current season. I certify that the child(ren) is in good health and physically able to participate. I absolve, indemnify and hold harmless the Carlisle Swim Club, CSC board, the coaches and CASL. I realize that I may be required to use my personal insurance coverage, or be otherwise responsible for any expenses resulting from injury. I will furnish, if requested, a certified birth certificate for my child. Photographs are sometimes taken of team activities for publicity and promotional purposes and children's names or information are never used without specific permission. With your signature below, you are releasing Carlisle Swim Club to use photographs of your child(ren) as stated.

Parent/Guardian Signature*

Payment Information

Member / Non-Member*

Member

Non Member

Swim Team Member Rate (Please select from drop down):

Swim Team Non-Member Rate (Please select from drop down):

Silicone Swim Caps ($10 each, OPTIONAL)

Required Chicken BBQ Tickets (5 per family)

Price:

Payment Method*

Online (Please note that there are additional processing fees when paying by credit card.)

Check

If paying by check make payable to:

Carlisle Swim Club

In memo indicate: swim team fees

Mail to: Carlisle Swim Club, PO Box 500, Carlisle, PA 17013

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

{all_fields}