Croasdaile Crocodiles
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2010 Online Registration Form
Welcome to the Croasdaile Country Club 2010 Season.
Register up to 3 swimmers at once (if more needed, add a new registration)
Double check your email address as this will be the primary method of communicating with you during the season
Must be a current Croasdaile Country Club member to participate
A registration fee of $75 per swimmer will be billed to your club account (see note). Fee includes swim team registration, T-Shirt and CCC Swim Cap.
Note: Submitting the registration form does not automatically enter the Croasdaile billing system. We will submit the registrations to Croasdaile to enter to your club account.
Swimmer Information
1st Swimmer Name
*
First
Last
Swimmer's Birthday (MM/DD/YYYY)
*
Gender
*
Male
Female
T-Shirt Size
*
Small
Medium
Large
X-Large
2nd Swimmer Name
*
First
Last
Swimmer's Birthday (MM/DD/YYYY)
*
Gender
*
Option 1
Option 2
Option 3
T-Shirt Size *
*
Small
Medium
Large
X-Large
3rd Swimmer Name
*
First
Last
Swimmer's Birthday (MM/DD/YYYY)
*
Gender
*
Male
Female
T-Shirt Size
*
Small
Medium
Large
X-Large
Parent Contact Information
Primary Contact for the swim season
*
Mother
Father
Both Mother and Father
Legal Guardian (Please list any unique considerations under Special Instructions section at bottom)
When registering both parents below, please list mother as first contact and father as second contact for consistency in our reporting.
First Contact
*
First
Last
First Contact Email
*
First Contact Phone #
*
-
-
Adult T-Shirt Size
*
Small
Medium
Large
X-Large
Second Contact
*
First
Last
Second Contact Email
*
Second Contact Phone #
*
-
-
Adult T-Shirt Size
*
Small
Medium
Large
X-Large
Address for Primary Contact or Family
*
Line 1
Line 2
City
State
Zip Code
Country
Croasdaile Club #
*
I authorize Croasdaile Country Club to bill my club account for the $75/swimmer for the swim team fee
*
Yes
Special Instructions
*