Swimmer 1:
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Group
Big Bucks
Gray
Scarlet 1 & 2
Scarlet Elite
Senior
Senior Elite
Muirfins 3:30-5:00
Muirfins 4-5
WHCC
Swimmer 2:
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Group
Big Bucks
Gray
Scarlet 1 & 2
Scarlet Elite
Senior
Senior Elite
WHCC
Swimmer 3:
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Group
Big Bucks
Gray
Scarlet 1 & 2
Scarlet Elite
Senior
Senior Elite
WHCC
Swimmer 4:
Birthdate:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
Group
Big Bucks
Gray
Scarlet 1 & 2
Scarlet Elite
Senior
Senior Elite
Muirfins 4-5
WHCC
Address:
City:
State:
Zip:
Parent's Names:
Home Phone:
Cell Phone:
E-Mail:
PRACTICE LOCATION :
.
Multiple Locations
Columbus North Sports Club
Northland
WHCC
Fees
After completing online registration, pleae mail a check payable to Buckeye Swim Club Boosters
for your registration fee to 3375 Brentwood Ct., Powell, OH 43065 or checkout via paypal.
Family Discount
Families with more than one swimmer participating will receive a discount on both their fundraising fee and their training fee, per the following schedule:
Two Swimmers: 5% discount
Three Swimmers: 9% discount
Four Swimmers: 12% discount
Please remember to include registration fees if appropriate.
Swimmer 1:
Swimmer 2:
Swimmer 3:
Swimmer 4:
Swimmer 5:
Total :
Less Discount:
TOTAL DUE:
MEDICAL INFORMATION
Doctors Name
Doctors Phone:
Emergency Contact
Contact Phone:
Medical Condition(s) & Medications:
Medical Waiver: I understand & agree that swimming is a hazardous activity. I recognize that there are risks inherent in the sport of swimming, including but not limited to, paralyzing injuries and death. The participant agrees to participate in the Buckeye Swim Club and hereby agrees to indemnify and hold harmless Buckeye Swim Club, its coaches, officers, directors, agents and employees against any liability resulting from any injury that may occur to the participant while participating in Buckeye Swim Club. The participant also agrees to indemnify Buckeye Swim Club for any damages incurred arising from claims, demand, action or cause of action by the participant. The participant authorizes any representative of Buckeye Swim Club to have the participant treated in any medical emergency during their participation in Buckeye Swim Club. Further, the participant and/or parent/guardian agrees to pay all costs associated with medical care and transportation for the participant.
Please initial here :
I Agree with the medical waiver