WAAC at Lakeway Swim Team Registration

WEST AUSTIN AQUATICS USA Swim Team Short Course 2009-2010 REGISTRATION

Sept. 1 –April 30

Please contact Coach Ginny at 263-4282 with questions or visit the website at www.wfly.com.

(If you have any problems registering online - please call Becky or Susan at 263-4282)

WAAC Swim Team at Lakeway Registration Form

* Parents Name

* Primary Phone

* Email Address

ALL Swimmers must fill out a 2010 USA Registration form. NEW WFLY swimmers must bring a copy of their birth certificate OR a copy of a USA Swim Card.

Contact Information

Address

City

Zipcode

Additional Contact Phone Numbers - Home, work, cell, mom, dad

Swimmer Information

Swimmers First Name

M.I.

Last Name

Age

Gender

Date of Birth

Past Swim Team Experience

Choose Training Group:

Goldfish M-Th 3:45-4:15 Sept. 1 – Nov. 19 $240

Dolphin M-F 4:15-5:15 $75/month

Shark M-F 5:15-6:30 $85/month

All swimmers must join USA Swimming which costs $66 annually. check here:

USA Swimming $66

Dolphin and Shark swimmers must pay $20 team fee 3 times a year (Sept, Jan, May). These fees fund team activities and merchandise such as the t-shirts, coach travel, patches, or anything else needed by the team.If Dolphin or Shark, check here:

Team Fee $20

Medical Information

Doctor to call in an emergency

Phone Number

Emergency Phone Number

Medical Insurance

Policy Number

Height

Weight

Date of last physical exam

Does the swimmer wear glasses or contact lenses?

Yes

Allergic to any medications or substances?

Yes

Please List

History of shoulder, back, head, or knee injury?

Yes

History of ear infections?

Yes

History of seizures?

Yes

Does the swimmer use an inhaler?

Yes

Currently taking medicine?

Yes

Please List

Is the swimmer current on all required immunizations?

Yes

Are there any other medical problems or condition the coach should know about?

I certify that the above named swimmer is medically and physically able to participate in West Austin Aquatics.

You must check here

* Indicates Response Required