Blank form registration – DRAGON SWIM CLUB

Billing Information

First Name

Last Name

Email

Billing Address

City

Province

Postal Code

Home Phone

Work/Mobile Phone

Guardian 1

Guardian 2

First Name 1

First Name 2

Last Name 1

Last Name 2

Mobile Phone 1

Mobile Phone 2

Work Phone 1

Work Phone 2

Emergencies

Emergency Contact

Secondary Emergency Contact

Emergency Phone

Secondary Emergency Phone

Member Information Child 1

of Middle Shirt

Legal First Name

Middle Name

Legal Last Name

Competitive Category

Gender

Date of Birth

Preferred First Name

Swimming Category

Pool Location

Shirt Size

Number of times per week

Preferred Training Days and Time

Please list the days of the week your child will attend (e.g., Monday, Wednesday, Friday) according to the schedule.

Medical Information

Physician Name

Physician Office Phone

Medical Information / Notes

Please inform us if your child has any disabilities, allergies, or special medical conditions we should know about.

Medication

List any medications your child is currently taking, or type ‘None’ if not applicable.

Please fill out this section only if you are registering a second child. Leave it blank if not applicable.

Member Information Child 2

Legal First Name 2

Middle Name 2

Legal Last Name 2

Competitive Category 2

Gender 2

Date of Birth 2

Preferred First Name 2

Swimming Category 2

Pool Location 2

Shirt Size 2

Number of times per week 2

Preferred Training Days and Time 2

Please list the days of the week your child will attend (e.g., Monday, Wednesday, Friday) according to the schedule.

Medical Information

Physician Name 2

Physician Office Phone 2

Medical Information / Notes 2

Please inform us if your child has any disabilities, allergies, or special medical conditions we should know about.

Medication 2

List any medications your child is currently taking, or type ‘None’ if not applicable.

Please fill out this section only if you are registering a third child. Leave it blank if not applicable.

Member Information Child 3

Legal First Name 3

Middle Name 3

Legal Last Name 3

Competitive Category 3

Gender 3

Date of Birth 3

Preferred First Name 3

Swimming Category 3

Pool Location 3

Shirt Size 3

Number of times per week 3

Preferred Training Days and Time 3

Please list the days of the week your child will attend (e.g., Monday, Wednesday, Friday) according to the schedule.

Medical Information

Physician Name 3

Physician Office Phone 3

Medical Information / Notes 3

Please inform us if your child has any disabilities, allergies, or special medical conditions we should know about.

Medication 3

List any medications your child is currently taking, or type ‘None’ if not applicable.

Dragon Swim Club Parent/Guardian/Swimmer Code of Conduct

I have read and agree

📄 View the the Dragon Swim Club Code of Conduct

Medical Release and Liability Waiver

I have read and agree

📄 View the Medical Release and Liability Waiver

Member Rules

I have read and agree

📄 View the Dragon Swim Club Member Rules