Polar Bear Registration Form Parent First Name * First Parent Last Name * Last Phone Number Email Address * Are there any medical or other circumstances we should be made aware of? Participant #1 arrowup6 Name * Birthdate * Age Group Practice * Age Group 1 (5-8yrs) 6:15-7:00PM M-ThAge Group 2 (9-10yrs) 6:15-7:15PM M-ThAge Group 3 (11-12yrs) 7:15-8:15PM M-ThAge Group 4 (13-18yrs) 7:15-8:30PM M-Th Please select your swimmer's age group. Participant #2 arrowup6 Name Birthdate Age Group Practice Age Group 1 (5-8yrs) 6:15-7:00PM M-ThAge Group 2 (9-10yrs) 6:15-7:15PM M-ThAge Group 3 (11-12yrs) 7:15-8:15PM M-ThAge Group 4 (13-18yrs) 7:15-8:30PM M-Th Participant #3 arrowup6 Name Birthdate Age Group Practice Age Group 1 (5-8yrs) 6:15-7:00PM M-ThAge Group 2 (9-10yrs) 6:15-7:15PM M-ThAge Group 3 (11-12yrs) 7:15-8:15PM M-ThAge Group 4 (13-18yrs) 7:15-8:30PM M-Th Additional Swimmers: Please include additional swimmers and age group practices here: (ie - more class choices) Photo Release I hereby give Four Seasons Association the unrestricted right and permission to copyright use photographic portraits, videos or pictures of these participant(s) or in which he or she may be included intact or in part, without restriction, with the purpose of now or hereafter club promotions, media coverage, and advertising. * Yes No
