8183 Elm Drive, Mechanicsville, VA 23111 P.O. Box 222 804.746.3061
Swimmer's Full Name: (1)
MRA SWIM TEAM REGISTRATION
Swimmer's Full Name: (2)
(Last, First, Middle Initial)
Swimmer's Full Name: (3)
Date of Birth
Age on 6/1/09
Is your child a USS or YMCA swimmer September - April?
Where?
If "Yes", please complete the Non-GRAL top times report. All winter times for the past two years are due by the first week of practice. (This will not include HS times). If not, you will be responsible for a $50 swimmer GRAL fine payable on June 2, 2009.
Mother's Information:
Name:
Home Phone:
Work Phone:
Cell Phone:
Email:
Father's Information:
Name:
Home Phone:
Work Phone:
Cell Phone:
Email:
Swimmer's Information:
Address:
Home Phone:
Email to be used for communication regarding swim team:
In the event of an EMERGENCY, the coach or Parent Representative of the MRA Swim Team has my permission to seek medical attention for my child. In such a situation, the parents would be contacted. If the parents are unavailable, the emergency contact is:
My health insurance number is:
EMERGENCY CONTACT NAME:
EMERGENCY CONTACT PHONE:
My hosptial choice is:
or the closest hospital.
My health insurance company is:
Please list any health concerns: diabetes, use of inhaler, heart murmurs, etc...
Fees:
Registration is $45.00 per swimmer(s). After May 30th, there is a $10.00 late fee.
How many swimmers are being registered?
X
$45.00 =
Practice Schedule will be as follows:(No Practices on Thursday Mornings)
MorningsMonday - Saturday
10 and under8 - 9 a.m.
11 and older9 - 10 a.m.
EveningsMonday, Tuesday & Thursday
8 and under 5 - 5:30 p.m.
9 -12 yr olds5:30 - 6:15 p.m.
13 and older6:15 - 7:00 p.m.
Please check one:
The swim meet dates are: 6/10, 6/17, 6/24, 7/1, 7/8 and 7/14. If there are any meets that you cannot attend, please note the date(s) below:
Are you interested in being an officer or on the board for next season?
Please indicate either your certified position on willingness to certify:
Meet Director
Strokes & Turns
Clerk of Course
Head Table Worker
The above child/children has/have my permission to attend the swim meets/practices for the MRA Swim Team. My family understands that we are required to provide a worker to work one half of each swim meet. My family is also willing to work a first half or second half of a meet as needed. If I cannot work a position that I have signed up for I will find my own replacement to work a scheduled session. I understand that my child/children will be expected to obey all rules of MRA, rules of other clubs we visit, and all rules set by the coaches.
By clicking "Submit Registration" below, you are agreeing to the terms noted above in this registration.
