Bulkley Valley Otters Swim Club
Spring Registration 2010
Registration Date: __________________________
Swimmer's Full Name: ____________________________________________________________
Mailing Address: ________________________________________________________________
Street Address (if different): _______________________________________________________
Home Phone: ____________________ Email: _______________________________________
Date of Birth (DD/MM/YYYY) ________________________________ Age: _______________
Care Card #: ______________________________ Gender (circle): Male Female
Father's name: _____________________________ Work Phone: ____________________
Mother's Name: ____________________________ Work Phone: ____________________
Medical conditions Coach should be aware of: ________________________________________________________________________
Emergency Contact: ______________________________ Phone: ___________________
Highest swim level completed: ___________________________________________________
Competitive Swim Experience: ___________________________________________________
Parent/Guardian Signature: ______________________________
Please make cheques payable to BVOSC. Thank you.
Registrar only:
SwimBC #: ______________________________ Swim group: ______________________
Training category: _________________________
Notes: ____________________________________________________________________________________________________________________________________________________________________________________________________
SwimBC fee $ _________ BV Otter Fee $ _________ Total $ __________
