High Lane Club
Swim and Dive Team Registration

Sunday MAY 20 2018 at 5:00pm

Child’s First and Last Name, Age, and Team choice:
(Swim & Dive, Swim only, Dive only)
 
1._____________________________________________________________
 
2._____________________________________________________________
 
3._____________________________________________________________
 
Parent’s name(s):________________________________________________
 
Email:_______________________________ Phone:_____________________
 
Emergency Contact Name:_________________________________________
 
Emergency Contact Phone:_________________________________________
 
Swim Team Cost:

• 1^st child $130
• 2^nd child: $240 total or $120 per child
• 3^rd child $330 total or $110 per child

Dive Team Cost:

• $100 1st child
• $80 2nd child
• $60 3rd child

Amount Paid:__________ CK#__________ Charge HLC Account: Y / N
 

Yes, I would like to help my coaches with (please √):

Awards night __  Ribbon/Trophy coordination __ or wherever needed __

**Each parent will be required to be a Time keeper (during all meets). Schedule to follow.

Thank You!