2009 BMAC Bluewave Registration Form

Please fill out one form per child and return with check (see below for fees) to:

Mrs. Carol Martin

10155 Canal Circle, Fairhope, AL, 36532

Which GCAAL Team did the Swimmer participate with last Summer?_____________________

If BMAC Bluewave.....how many years has child participated?___________________________

Has Your Family Moved to a New Home in the Last Year? y______  n______

Swimmer's Full Name:___________________________________________________________

Age of Swimmer as of June 1st/09:________________________________________________

Swimmer's Birthdate:____________________________________________________________

Swimmer's Address:_____________________________________________________________

Swimmer's Home Phone Number:__________________________________________________

Mother's Name:__________________________________________________________________

Mother's Home Phone#:_________________Cell#________________Work#_________________

Father's Name:__________________________________________________________________

Father's Home Phone#:_________________Cell#_________________Work#________________

Emergency Contacts:

Name: ________________________relationship to child:_______________________________

home#_________________________cell#_____________________work#_________________

Does this swimmer have any medical conditions that we as coaches need to be made aware of

or any emotional problems:  Please explain (for coaches use only):_______________________

_____________________________________________________________________________

_____________________________________________________________________________

Fees:  $150.00 (price includes $50.00 towards GCAAL registration, all meets fees and a trophy)

        

We give discounts for families with multiple children:

First Child :  $150.00

Second Child :  $150.00

Third Child:  $110.00

Fourth & Up Child:  $50.00