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NYC Swim Team/Swim Lessons

Family Medical Form


Family Name____________________________________________________________
Family Home Phone Number_______________________________________________
Family e – mail address__________________________________________________
Family Address__________________________________________________________
Mothers Name and Cell Phone______________________________________________
Father’s Name and Cell Phone______________________________________________
Emergency Contact person other than Parent___________________________________
Emergency Contact’s home and cell phone number______________________________
______________________________
Family Doctor________________________
Doctor’s Phone #_____________________

Family Dentist_______________________
Dentist’s Phone#_____________________

Family Insurance______________________

If there are any medical or emotional concerns please place on back. All information will be kept
confidential.

Family Swim Team Application


1 child--$250 2 children--$450 3 children--$600

Please fill in application putting your oldest child’s information first, your youngest child’s last.

First (Oldest) Swimmer’s Name_______________________


Swimmer’s Birth date________________________
Age group they will be for the 2010 swim season. The cut off date is July 1, 2006. This means whatever
age your child is on July 1st is the age group they will swim in for the season.
8&Under___ 10&Under____ 12& Under_____ 14& Under_____17& Under_______

Second Swimmer’s Name____________________


Swimmer’s Birth date________________________

8&Under___ 10&Under____ 12& Under_____ 14& Under_____17& Under_______

Third Swimmer’s Name_____________________


Swimmer’s Birth date________________________

8&Under___ 10&Under____ 12& Under_____ 14& Under_____17& Under_______

Forth Swimmer’s Name____________________


Swimmer’s Birth date________________________

8&Under___ 10&Under____ 12& Under_____ 14& Under_____17& Under_______

Are any of the children mugging out? ______


If yes, please write their name_______________
(A child may mug out if due to their age they are ineligible, or they have graduated H.S.
already.)
NYC Swim Lesson Registration
Swim Lessons will start from Monday June 28th and run 5 days per week until 25 lessons
are fulfilled, not going past Wednesday August 4th.
Lessons will be held on July 2 and 5th.
Competitive lessons will run Monday thru Thursday each week (no Fridays).
Swim lessons are $150 for regular and $75 for competitive.
PRICING FOR ALL SWIM TEAM AND SWIM LESSONS IS NOT PRO-RATED FOR
VACATIONS, OTHER SPORTS, ETC.

All lessons are subject to change due to weather and pool conditions. Every effort will be
made to make up lessons, but due to certain time constraints this is not always possible.

First child’s name_________________________


Child’s Age______________________________

Second child’s name_______________________


Child’s Age______________________________

Third child’s name________________________


Child’s Age______________________________
Competitive Lessons

First child’s name_________________________


Age____________________________________

Second Child’s name______________________


Age____________________________________

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