Athlete's Name       

Parent's Name        

Address                 

City                      

Postal Code           

Phone (Day)              

Phone (Night)       

Email                   

Birth Date (mm/dd/yy)      

Highest Swimming

Level Completed (if known)

Emergency Contact            

Emergency Phone Number  

Please check the camp you'd like to register for:

April 21st - 25th, 7pm - 8pm - $60

All registrations will be confirmed with a phone call.

Please Contact Us if you need more information.

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