Otter Swimming 2012
Name:_________________________________________ Age:_______ Sex:______ DOB__________
Class Time:_____________ Class Name:_________________ Session Dates:_____________________
Email Address:______________________________________________ Shirt Size (team only)____________
Parent's Names:_____________________________________________________________________________
Home Phone:_____________________ Cell Phone:_________________ Cell Phone:_________________
Address:___________________________________________________________________________________
Additional Contact Information:
Name:____________________________________________________________ Phone:__________________
Please list all of your child's medical problems. You may also add any information you think might
help us understand your child better. ________________________________________________________________
_____________________________________________________________________________________________
______________________________________________________________________________________________
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By signing below, you understand Courts Plus, any coach and/or volunteer will not be held liablfor any accidents.
Understand your child is participating in a sporting event where accident can occur. You will not hold Ms. Pat, any
assistant coach or Courts Plus responsible for any accident.
Parent's Signature:_________________________________________________________ Date:_________________
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