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2019-20 Pre-Fins Registration Form
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* Indicates required question
First Name
*
Your answer
Middle Name
*
Your answer
Last Name
*
Your answer
Preferred Name
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Is your child a U.S. citizen?
*
Yes
No
Does your child have any medical conditions or allergies we should know about? If so, please list them:
*
Your answer
Address
*
Your answer
Mother's Name
*
Your answer
Mother's Phone
*
Your answer
Mother's Email
*
Your answer
Father's Name
*
Your answer
Father's Phone
*
Your answer
Father's Email
*
Your answer
Swimmer's Race and Ethnicity
*
Black/African American
Asian
White/Caucasian
Hispanic/Latino
American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Other:
Disability Information (check up to 2 choices)
*
Legally blind or visually impaired
Physical disability, such as amputation, cerebral palsy, dwarfism, spinal injury or mobility impairment
Cognitive disability, such as severe learning disorder or autism
Other:
Required
Has your child swam on a year-round swim team before?
*
Yes
No
If yes, which one and when?
*
Your answer
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