MONMOUTH BARRACUDAS SWIM CLUB
Announce New Swimmer Tryouts
for the 2016/2017 Season
Friday July 29th at 6:30pm at the Neptune Aquatic Center
Competitive year round swim club for ages 6 to 19
Practices starting in September
Training sites: Neptune Aquatic Center and The JCC in Deal
Registration Form is below!
COME JOIN THE FUN AND LEARN TO SWIM FAST!!!
Monmouth Barracudas Swim Club
2017.2018 Swim Season
C/O Preferred Billing PO Box 304 Lincroft, NJ 07738 Billing Ph.: 732-842-0431 Fax: 732-842-0432
*Current Group Name:______________ (office use only) *One Form Per Swimmer
Swimmer’s Name:__________________________________________ Parents Name_____________________________
(* include your middle initial) First/Middle Initial/Last
Date of Birth _________M/D/Y Age:_______ Address/City/Zip:__________________________________________
Ph.:732_____________________Cell:______________________ Emergency Contact:____________________________
EMAIL REQUIRED!:__________________________Allergies/Medical Conditions:____________________________
PLEASE PRINT – your e-mail must be legible
The above named child is in good physical condition and has my permission to train with and participate in all activities sponsored by the Monmouth Barracudas Swim Club, Inc. I understand that my child will be participating in strenuous practices, strength training programs, as well as learning competitive techniques. I release and hold harmless the Monmouth Barracudas Swim Club, Inc., Director and owner Paul K.
Buerck, all assisting staff members, coaches, volunteers, centers, facilities, organizations, and their heirs and estates associated with this permission. I hereby give permission to authorized representatives of the Monmouth Barracudas Swim Club, Inc. to obtain emergency medical treatment for said child while he/she is participating in Monmouth Barracudas activities. I understand every effort will be made to contact me first. Furthermore, I understand that once I register my child for Fall 2016/2017 swim season. I am required to pay for their full session of swimming (whether my child completes the entire session or not for reasons such as loss of interest, illness, injury, separation or divorce).
Monmouth Barracudas Swimming reserves the right to assign swimmers to sessions and to limit the number of participants. Once your $200 deposit is received this will reserve your child’s spot and the registration form, practice schedule and fees will be sent.
No Refunds once your spot has been reserved.
Date: _______ Parent/Guardian Signature__________________ Swimmer Signature__________________