SOLECO SWIM TEAM REGISTRATION

SOLECO SWIM TEAM REGISTRATION 2008

*********** PLEASE PRINT CLEARLY **********

Last Name: _____________________________			First Name: __________________
Street Address: __________________________________________________________
City: _________________		State: PA	Zip Code: ___________________
Home Phone Number: ____________________			Township: __________________
Sex: __________	Birthdate: _____________		Age as of May 31, 2008 _______

Parent or Guardian’s

Last Name: ____________	First Name: ____________	Work/Cell #: _____________
Last Name: ____________	First Name: ____________	Work/Cell #: _____________

Email address _______________________________________________________

Child’s T-shirt size (please circle one) Adult S M L Child S M L

NOTE: Pool membership must be paid in full by May 24th. A swimmer cannot participate in an in-the-water practice until membership payment is received!!!

2008 REGISTRATION: $50 / SWIMMER

We ( I ) , the undersigned parent or guardian, understand that the staff of the Soleco Booster Club will endeavor to provide for the safety of all swim team participants. We ( I ) , do, however, agree to indemnify and otherwise hold harmless the Soleco Booster Club and Soleco Community pool, and all agents of the swim team, should an injury occur to my child listed on this form. If for any reason an injury, illness or any medical emergency occurs during practice or a meet, the Soleco Booster Club will have my permission to call for emergency assistance. We ( I ) have insurance coverage which we ( I ) feel is adequate. We ( I ) understand clearly that the organizers of the Soleco Booster Club do not carry medical insurance.

INSURANCE COMPANY______________________ POLICY NUMBER______________________

PARENT or GUARDIAN’S SIGNATURE(S) Below

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