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 ____

Swimmer                      ____

Diver                            ____

Swimmer and Diver      ____

USS or USD # ______________________      Expiration date_______________________

Fees enclosed:

            Swimming registration________

            USS insurance fee       ________ (this fee not applicable if swimmer is already a USS  member)

            Diving registration      ________

            USD insurance fee      _________ (this fee not applicable if diver is already a USD  member)

             Total fees enclosed     ________

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

Please make checks payable to the Knolls Swim Club and send with completed form to: Cheryl Barbour (Swimming) or Donna Thompson (Diving)