WCAY Swim Team Registration Form

Bring this filled out form and payment to WCAY Membership Desk

q Fall Clinic                 q  Winter Team          q  Spring Clinic           q  Summer Team

(Please Print)

Swimmer’s Name ____________________________________________Date of Birth _____________   Age______

Address _____________________________________________________________                 M ______   F ______

City/State/Zip  _________________________________________________

Preferred Email: _________________________________________________

Mother’s Name  ________________________________________________

Father’s Name  ________________________________________________

Home Phone_________________

Cell ________________________

Cell________________________

Please list any allergies or current medications

 _____________________________________________________________________________________________

Has the Swimmer swum with the YMCA Marlins before?  No  _____  Yes  ______  What level?_____________________

VOLUNTEERS ARE NEEDED  -  All Swim Team Parents are expected to volunteer at swim meets and throughout the season. A new on-line volunteer sign-up is available at www.wcayswim.com or contact the volunteer coordinators.

____________________

Informed Consent/Liability Waiver – I release the West Chester Area YMCA and its coaches from all claims of any injuries which may be sustained by the swimmer named on this form while participating in any YMCA sanctioned activity.  If emergency medical care is required, I give permission for such care.

Parent/Guardian Signature: _________________________________________ 

**  PLEASE PRINT, FILL IN SIGN & RETURN TO MEMBERSHIP DESK **

Date __________________________

Rcpt. #  ________________________

Staff Initials  ____________________