Parent Name *

First Name

Last Name

Phone

(###)

###

####

Swimmer's Name

First Name

Last Name

Swimmer's Birthdate

MM

DD

YYYY

Is your child available during the week (Monday-Friday) between the times of 5pm and 8:15pm?

Yes (child is available each of those days during that time frame)

Child is available most days during that time frame

Child is available only some days during that time frame

Child does not have availability throughout that entire time frame

After your child has attained competitive swimming skills, how many days per week would you anticipate them training on a regular basis? *

Not including vacation weeks or unexpected times out of the pool. *Note* If your child is only able to show up a maximum of three days per week or less, please wait until your schedule has more availability/flexibility.

1-2

2-3

3-4

4-5

5 or more

How soon would your child be ready to start if he/she passes the assessments?

Right Away

1-2 weeks

2-3 weeks

Longer

Would the swimmer have difficulty arriving to practice on time consistently?

No

Yes

Possibly