Raptors Swim Clinic SPRING 2016
Raptors Swim Clinic SPRING 2016 Sundays: April 3, 10, 17, 24 11:00 am – 12:00 pm Please send in one form for each swimmer you are registering
Swimmer’s Name ___________________________________________________ Age ______
Birthdate __________________
T-Shirt Size: Youth: S M L / Adult: S M L XL Swim Experience __ USA Swim __ High School
Gender:
Male
Female
Current Grade in School _____________ __ ESSL
__ DUSO
__ None
Address ___________________________________________________________ City _____________________________ State ____________ Zip ___________ Home Phone ______________________ Cell Phone _______________________ E-Mail _____________________________________________________________ Parent/Guardian ____________________________________________________ Payment is due with registration. $60.00 per swimmer. Checks may be made payable to Bard College and sent to: Bard College, Department of Athletics, PO Box 5000, Annandale, NY 12504. The undersigned parent/guardian of the registrant, for and in further consideration of the Bard College Raptors Swim Clinic accepting said registrant, hereby agrees to save and indemnify and keep harmless the said Bard College Raptors Swim Clinic, its agents and sponsors against any and all liability, claims, judgments or demands arising as a result of any course of instruction or activity given the registrant by the above mentioned program. ________________________________ _________________ Signature – parent/guardian
Date
Swimmer’s Name ___________________________________________________ Age ______
Birthdate __________________
T-Shirt Size: Youth: S M L / Adult: S M L XL Swim Experience __ USA Swim __ High School
Gender:
Male
Female
Current Grade in School _____________ __ ESSL
__ DUSO
__ None
Address ___________________________________________________________ City _____________________________ State ____________ Zip ___________ Home Phone ______________________ Cell Phone _______________________ E-Mail _____________________________________________________________ Parent/Guardian ____________________________________________________ Payment is due with registration. $60.00 per swimmer. Checks may be made payable to Bard College and sent to: Bard College, Department of Athletics, PO Box 5000, Annandale, NY 12504. The undersigned parent/guardian of the registrant, for and in further consideration of the Bard College Raptors Swim Clinic accepting said registrant, hereby agrees to save and indemnify and keep harmless the said Bard College Raptors Swim Clinic, its agents and sponsors against any and all liability, claims, judgments or demands arising as a result of any course of instruction or activity given the registrant by the above mentioned program. ________________________________ _________________ Signature – parent/guardian
Date
