St Louis Spirit Swimming Registration 2007
Name of Swimmer
Last First (name on birth certificate) Middle.
Preferred name for listing in meet programs________________________________________________________________
Address______________________________________________
________________________________________________________________________
email____________________________Birthdate _______/_____/______
Home Phone___________________________________________
Parents__________________________________________________________________
Address (if different from swimmer)________________________________________________________________
Email_Mother__________________________Father_____________________________
Mother Work_____________ Cell______________ Home______________
Father Work______________Cell______________Home______________
____I attest to my child’s good health and ability to swim at practices and at meets.
____My child has the following medical considerations______________
__________________________________________________________
My child is on the following medication, regularly._____________________
Consent for Medical Treatment
I, the undersigned, hereby authorize and consent to any first aid, medical treatment, medication and surgery deemed necessary in case of an emergency.
Parent/Guardian Signature
Emergency Contacts_________________________________________________