PLEASE FILL OUT A FORM FOR EACH SWIMMER/DIVER IN YOUR FAMILY

Swimmer’s/ __________________________________________________________ M     F 

Diver’s Name                           Last                              First                             MI       Circle one

Address__________________________________________________________________

E-Mail Address ____________________________________________________________ 

Date of Birth __________________________ 

Telephone #  __________________________              Cell # ________________________

Parent’s Name ____________________________________________________________

Member of Town Pool: Yes ____   No ____

Check one below:

Swimmer                        __________

Diver                              __________

Swimmer and Diver        __________

USS and/or AAU # ______________________      Expiration date(s) _______________________

Fees enclosed:

Please note: The check for these fees must be separate from the swimwear payment.

Swimming fee __________     USS Insurance fee _________ (N/A if swimmer already a USS member)

Diving fee _________     AAU Insurance fee __________ (N/A if swimmer already a AAU member)

Total fees enclosed  __________ Check #  _________ 

 Make checks payable to the Knolls Swim Club and send completed form to:

Swimming: 664-4151                                            Diving: 290-5518
Jill Dougherty                                                       Amy Salzone
102 Lower Newtown Road                                  27 Tarragon Terrace
Waterford, NY 12188                                          Clifton Park, NY 12065