Swimmer #1 Name *

First Name

Last Name

Swimmer #1 Birth Date *

MM

DD

YYYY

Swimmer #2 Name *

First Name

Last Name

Swimmer #2 Birth Date *

MM

DD

YYYY

Swimmer #3 Name *

First Name

Last Name

Swimmer #3 Birth Date *

MM

DD

YYYY

Swimmer #4 Name *

First Name

Last Name

Swimmer #4 Birth Date *

MM

DD

YYYY

Parent's Name #1 *

First Name

Last Name

Parent's Name #2

First Name

Last Name

Parent's Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact's Phone *

(###)

###

####

Additionally *

I understand that the Vistancia Vipers Swim Team does not provide babysitting services and I am expected to drop off and pick up my children at their designated practice times.

I understand that it is my responsibility to behave in a positive manner to the coaches and other parents. My children are expected to behave in a respectful manner to both his/her coaches, other teams and fellow swimmers to ensure that all swimmers have a positive experience.

My child is able swim a full length of the pool (25 yards) both unassisted and without stopping.

Vistancia Village A Resident? *

Yes

No