Northfield, Minnesota, USA


Swim Camp Registration

If you prefer, you may print out and mail a registration
form
.

















General Information
Camper’s first name:
Camper’s last name:
Address:
City:
State: AA
AE
AK
AL
AP
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
ZIP:
Parent/guardian name:
E-mail:
Phone:
Roommate requested (one only;
roommates must request each other):
Gender:
Female   
 Male
Date of birth (dd/mm/yyyy)
Club or school team:
Grade completed in June 2005:
T-shirt size: Child size:

S  


Adult size:

S  


L  
XL








Camp selection.

Please rank your date preferences in the event your first
choice is full.
RANK12345 High Performance June 12-16 $445
RANK12345 Stroke Technique June 12-16 $415
RANK12345 High Performance June 19-23 $445
RANK12345 Stroke Technique June 19-23 $415
RANK12345 High Performance June 26-30 $445
RANK12345 Stroke Technique June 26-30 $415
















Emergency Contact Information
Name:
Relationship to camper:
Phone 1:
Phone 2:
Alternative emergency contact:  
Name:
Relationship to camper:
Phone 1:
Phone 2:
Please tell us if your child has any medical
condition, including possible reactions to prescription medication
or allergies that we should be aware of
Insurance provider:
Policy number:
Insurance provider phone:
I have read and agree to the parent
waiver
.

 






Fees and Payments   Total
  Camp Fee Enter fee from schedule above $
  Family Discount $20 discount for each sibling when registrations are
submitted online on the same day
$-
  Late Registration: $25 fee for registrations postmarked after May 15 $
    TOTAL REGISTRATION FEES $









Credit card information  
Credit card: SELECT CARDVisaMasterCardDiscover
Card number

(enter numbers only, no spaces or hyphens):
Expiration month: MONTH010203040506070809101112
Expiration year: YEAR20042005200620072008200920102011201220132014
Name on card:
   
Please review all information before submitting.