Kidz Aquatic Swim Club - Online Registration

Instructions To become a Kidz Aquatic Swim Club member, complete this registration. Once you complete the registration, you are immediately eligible to participate.

* Starred fields are required

Swimmer Information

First Name *

Preferred (Nickname)

Middle Name *

Last Name *

Create Password

Sex *

Female Male

Birth Date *

School

Phones

Home

Cell

Texting Cell

Mobile provider

Email *

Country *

Street *

Street 2

City *

State *

ZIP Code *

Club/Team

(Maximum of 5 alphanumeric characters)

Club/Team Name

Member ID

(14 characters formatted MMDDYYFFFMLLLL)

Emergency Contact

Name *

Relation

Phone *

Name 2 *

Relation 2

Phone 2 *