CFB Kingston Sharks Swim Club

Registration Form

REGISTRATION FORM

SEASON 2010 - 2011

SWIMMERS INFORMATION

Last Name: ____________________________		First Name: ____________________________
Address: ______________________________		Phone: _______________________________
Postal Code: ________________	Email: ___________________	DOB (dd/mn/yr): _________________	Last Club: __________________
Medical Concerns: (incl allergies, med alerts etc: _________________________________________ ___________________________________________________________________________________
School: ______________________________		School Phone: _____________________________
Level Requested: ______________________		Swim Club Last Year: _____________________
PARENT INFORMATION
A. Last Name: _________________________		First Name: _____________________________
Address: ______________________________		Phone: _________________________________
Email: ________________________________		S/N or PRI: _____________________________
Unit: __________________________________		Work Phone: ___________________________
B. Last Name: _________________________		First Name: _____________________________
Address: ______________________________		Phone: ________________________________
Email: ________________________________		Work Phone: ___________________________
MEMBERSHIP TYPE (circle one)		For Office Use Only
REGULAR – CF Members		Registration:	__________________
		CRA charge:	__________________
ORDINARY – DND/NPF Employees & Ret’d mil		TOTAL:	__________________
		Payment:	Cash: __ Cheque: __
ASSOCIATE - Others		Receipt #:	_________________
		Date:	_________________
		Team Official:	_________________