R/G R

MONTGOMERY

STROKE & TURN CLINIC

SUNDAY EVENING SWIM CLINICS

Swimmer's 25/50 yard or meter freestyle time: *

PLEASE READ AND FILL-OUT ALL REQUIRED FIELDS OF THE REGISTRATION FORM AND CLICK THE "I AGREE" BUTTON TO REGISTER ONLINE. THEN CLICK THE "SUBMIT" BUTTON TO BE DIRECTED TO THE PAYMENT PAGE WHERE YOU CAN SELECT YOUR DESIRED CLASSES AND PAY VIA PAYPAL. REGISTRATION IS COMPLETE WITH RECEIPT OF PAYMENT.

If you have any questions please email us at info@mstcswim.com

Parents Email: *

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Parents Name: *

Parents Contact Number: *

Emergency Contact Name: *

Choose Camp(s): *

FREESTYLE 8/29-8/30 8:40-9:30 (2 practices, S,U):$40

8 & UNDER FREE 8/29-8/30 9:40-10:30 (2 practices, S,U):$45

BACKSTROKE 9/5-9/6 8:40-9:30 (2 practices, S,U):$40

8 & UNDER BACK 9/5-9/6 9:40-10:30 (2 practices, S,U): $45

Emergency Contact Number: *

Swimmer's Name and Date of Birth : *

Parents Mailing Address *

MSTC SUMMER TECHNIQUE/TRAINING CAMP AT ARGYLE COUNTRY CLUB ONLINE REGISTRATION FORM

The participant assumes all risks associated with participation in the program; MSTC assumes no liability for injury or damages arising from participation in the program. Due to the strenuous nature of some activities, MSTC encourages each participant to consult his or her physician concerning fitness to participate in the program. The participant consents to emergency treatment. The participant also consents to MSTC's use of any photographs taken or video tapes made of the program. If the participant is a minor, the parent or guardian approves his or her participation in the program. I, by confirming agreement, do hereby indemnify and hold harmless Montgomery Stroke and Turn Clinic Inc., Argyle Country Club, or any servants, agents, proprietors or employees of the above from any and all liability, damage, expense, cause of action, suits, claims or judgments arising from injury to person or personal property or otherwise which arise out of the act or failure to act or negligence of the participants in connection with or arising out of the use of the facilities for this program. *

I Agree

Additonal Information You would like to share about your swimmer:

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