West Austin Athletic Club
Swim Lesson Registration
Swim Lessons Registration Form
*
Participants First Name
*
Last Name
*
Age
*
Date of Birth
*
Parents Name
*
Primary Phone
*
Email Address
Contact and Swimmer Information
This information is required only if this is the first West Austin form you have completed in 2011.
Address
City
Zipcode
Additional Contact Phone Numbers - Home, work, cell, mom, dad
Doctor to call in an emergency
List any medical information that the swim staff should know including allegies, medications, disorders, seizures, asthma, anything you think important
Do you give permission for your child to go down the slide or off the diving boards
Yes
No
Club Member?
*
Are you member of the club?
Yes
No
If a member of the club, what is your member number?
If not a member consider becoming a member of the club. Enjoy WAAC's facilities
and get discounts on programs. Quarterly Family Memberships cost $525 and
Annual Memberships cost $90/month.
*
Indicates Response Required