Registration

Athlete's Name*
First Last
Birthdate*
YYYY slash MM slash DD
Address*
Street Address Address Line 2 City Province Postal Code
Email*
Phone*
Emergency Contact Name*
First Last
Emergency Contact's Phone*
Relationship*
Personal Health Number*
BC Care Card number or the PHN found on the back of your driver's license.
Name of Doctor
Doctor's Office Phone
Health Overview
Please provide info for our confidential files.
- Allergies
- Asthma (respiratory)
- Blackouts / Fainting
- Chest pain
- Diabetes
- Epilepsy
- Hearing disorder
- Heart condition
- Headaches (recurring)
- Seizures
- Injuries
- Physical limitations
- Corrective lenses
- Medications
Notes
Comments regarding checked items on Health Overview.
Notes for Coach Courtney
Do you have artistic swimming experience (not required)?
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

Artistic (Synchronized) Swimming club for women age 19+. Beginner, intermediate and advanced. We swim from September through May.

HOME POOL:
Walnut Grove Community Centre Pool
8889 Walnut Grove Drive
Langley, BC V1M 2N7

| Artistic (Synchronized) Swimming for women age 19+ |