Manchester Swim Team

Registration Form 2008-09

Athlete Information
Last Name:		First Name:		Middle:
Preferred Name:		Birthdate (m/d/y):		Age:
School Year:		Cell:
Gender (M,F):		Email:

Mailing Information
Father's Last:		Father's First:
Mother's Last:		Mother's First:
Mailing Address:
Mailing Address:
City:		State:		Zip Code:

Contact Information
Home Phone:
Father Work Phone:		Cell:		Email:
Mother Work Phone:		Cell:		Email:

Medical Information

Date of most recent physical:

Medical Conditions, known medications not to be taken, and any other problems we need to know

Swimming Experience (List events and times)

Program Fees		Equipment Needed
USS Registration Fee:	$60.00	Fins, Pull buoy, Goggles, Bathing cap, Multiple swim suits
Escrow account for meet fees per swimmer :	$100.00
Team Fee (see Steve for details):		Note: Check web site for practice times, new information about meets, changes, etc. Virtually all information about the team will be posted here. Check it frequently (2-3 times a week). www.manchesterswimteam.com
Amount due:
Total paid:
Team fees due prior to swimmers participation or at registration.
Make checks payable to: Manchester Swim Team

Parents willing to help - please note your interests:

1. Timing or helping at meets (no experience necessary)

2. USAS Official please indicate your current certification level: Stroke & Turn Starter Referee

3. Transportation when needed

4. Fund raising

5. Other

Steve Van Der Beken (Head Coach) Home/Work: 623-4179

Andy Bonte (Coach) HomeL 627-9512

Jeannie Mitchell (Coach) Home: 668-9048