GAINESVILLE HIGH SCHOOL SWIMMING AND DIVING REGISTRATION

First Name *

Last Name *

Middle Name *

Birthdate * +

Gender *

Address *

Address 2

City *

State/Province *

Zip/Postal Code *

Student Phone *

Student Email *

Shirt Size *

Suit Size

Graduation Year *

USA Swimming ID #

Guardian #1 Name *

Guardian #1 Phone Number *

Guardian #1 Email Address *

Guardian #2 Name

Guardian #2 Phone Number

Guardian #2 Email Address

Emergency Contact Name (other than guardian) *

Emergency Contact Phone Number *

Physician Name *

Physician Phone Number *

Medical Conditions/Medications/Limitations