Long Beach Shore Aquatics

Online Registration

Step 1 of 3
Biographical Waiver Payment Confirmation
Welcome to Long Beach Shore Aquatics Swim Team!!! (To register for Water Polo, click here.)

Instructions: To become an Swim Team member, please complete this 2-step registration form. On step 2 you will be asked for your credit card (Visa, MasterCard) information. Once you complete step 2 and submit the form, you are immediately eligible to participate.

SWIMMER INFORMATION:
* Starred fields are required
First Name *
Preferred (Nickname)
Middle Name
Last Name *
Create Password
Sex *  
Birth Date (mm/dd/yyyy)
School  
Phone
Home/Primary
Secondary
Cell/Other
Texting
Cell number to receive texts
Cell phone service provider
Email
Street
Street 2
City
State
ZIP
Club/Team Affiliation
Club/Team (Maximum of 5 alphanumeric characters)
Club/Team Name
Member Number (14 characters formatted MMDDYYFFFMLLLL)
USWP Number Exp. Date (12/31/yyyy)   USWP information/Sign-up
Left/Right-handed? Left   Right   Both
Parent/Guardian   1)   2)
Emergency Contact (Parent, Spouse, etc)
Name *   Relation
Phone *
Name 2 *   Relation 2
Phone 2 *

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