2024 Nassau Swim Team at Broadmead Registration
We need a completed form for each family with swimmers joining the Nassau Swim Team at Broadmead. Completion of this form will result in families receiving an invoice for the full season. NO refunds will be granted, so please be sure of your swimmer(s)' desire to participate before enrolling them.
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Parent/Guardian 1 First Name *
Parent/Guardian 1 Last Name *
Parent/Guardian 1 email address (this is where we'll send your invoice) *
Parent/Guardian 1 cell phone number *
Parent/Guardian 2 First Name
Parent/Guardian 2 Last Name
Parent/Guardian 2 email address
Parent/Guardian 2 cell phone number
Emergency Contact name, relationship to swimmer(s), and phone number *
Names of any other adults authorized to pick up swimmer(s) after practice
Health Insurance covering the swimmer(s) (Enter carrier and policy number, please.) *
Swimmer 1's First Name *
Swimmer 1's Last Name *
Swimmer 1's gender *
Swimmer 1's pronouns *
Swimmer 1's Date of Birth *
MM
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DD
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YYYY
Swimmer 1's age as of June 1, 2024 *
Swimmer 2's First Name
Swimmer 2's Last Name
Swimmer 2's gender
Swimmer 2's pronouns
Swimmer 2's Date of Birth
MM
/
DD
/
YYYY
Swimmer 2's age as of June 1, 2024
Additional swimmers? For each additional swimmer in your family, please provide name, gender, pronouns, birthdate, and age as of 6/1/24 for each in the space below.
Membership Level *
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