Registration – Urbanna Swim Club

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Urbanna Otters Swim Team Registration

Please fill in all registration information below. Otter Pups are children that are learning to swim and are not ready to be entered in a swim meet, the goal is to get them comfortable enough to be in one meet by the end of the season, but not a requirement and is up to the coach to say when they are ready.

Swim Team Registration

Parent 1 First Name

Parent 1 Last Name

Parent 2 First Name

Parent 2 Last Name

Parent 1 Email

Parent 2 Email

Parent 1 Phone/Mobile

Parent 2 Phone/Mobile

Address

Address Line 1

Address Line 2

City

State

Zip Code

Urbanna Swim Club Member

Yes

No

Urbanna Member Number

Swimmer Information

New To Team

Yes

No

Number of swimmers

Otter Pup

Yes

No

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Female

Male

Shirt Size

Otter Pup

Yes

No

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Female

Male

Shirt Size

Otter Pup

Yes

No

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Female

Male

Shirt Size

Otter Pup

Yes

No

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Female

Male

Shirt Size

Otter Pup

Yes

No

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Female

Male

Shirt Size

Otter Pup

Yes

No

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Female

Male

Shirt Size

Otter Pup

Yes

No

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Female

Male

Shirt Size

Otter Pup

Yes

No

First Name

Last Name

Date of Birth (mm/dd/yyyy)

Gender

Female

Male

Shirt Size

Medical Information

Physician

Physician Telephone Number

Insurance Company

Insurance Policy Number

Privacy Information

Pictures are taken during team activities and may be posted on our website. Would you like your swimmer(s) excluded from pictures?

Yes

No

Pictures are taken during team activities and may be posted on our private Facebook group. Would you like your swimmer(s) excluded from pictures?

Yes

No

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