2021 Polo Fields Piranhas Swim Team Registration

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Thanks for your interest in our swim team. Please fill out this form for your family.

*Please NOTE- This team is located in Louisville, KY

Swimmer Information

Family Last Name *

This name will be used on the family ribbon folder

Does your family have a Polo Fields Social Membership? *

Yes

Swimmer #1: Name, Birthdate, Sex *

Pay close attention to spelling, this information will be used for meets and trophies

Select T-shirt size for Swimmer #1 *

Swimmer #2: Name, Birthdate, Sex

Pay close attention to spelling, this information will be used for meets and trophys

Select T-shirt size for Swimmer #2

Swimmer #3: Name, Birthdate,Sex

Pay close attention to spelling, this information will be used for meets and trophys

Select T-shirt size for Swimmer #3

Swimmer #4: Name, Birthdate, Sex

Pay close attention to spelling, this information will be used for meets and trophys

Select T-shirt size for Swimmer #4

Family Information

Parent/Guardian #1 Name *

First and Last name

Parent/Guardian #2 Name

First and Last name

Family Address *

Phone Numbers *

Please list any phone numbers you would like us to have

Email Addresses *

Please list all email addresses you would like us to have. Make sure to identify owner of the email and include swimmer email addresses if appropriate

Medical Release

If Medical care is required for the following children, in conjunction with any practice, meet or activity, and if normal permission is not available in a timely manner, the undersigned authorizes appropriate medical care as deemed necessary by emergency medical personnel, a physician, or the medical facility providing treatment. *

List your children's names

Emergency Contact Name and Phone number *

Pediatrician Name and Phone Number *

Insurance Carrier, Policy #, Policy Holder Name and Group #

As a parent or guardian of the above named child, If I am not present, please attempt to contact me at the time of the accident or illness without postponing medical treatiment. My checking the box I agree this entire release and agree to it. *

I agree

Required

Do you want to order additional t-shirts for $10/each? If so, list sizes below

All swimmers get a t-shirt with registration, these shirts are for siblings or adults.

Submit

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