Blue Wave Aquatics

Trial Workout

Step 1 of 3
Biographical Waiver Payment Receipt
Free week of swim team practice. After your free week of swim team practice, you will receive a 50% discount on 1st month's dues!
* Starred fields are required
First Name *
Preferred (Nickname)
Middle Name
Last Name *
Birth Date * (mm/dd/yyyy)
Phone
Home/Primary
Work/Secondary
Cell/Other
Email *
Street *
Street 2
City *
State*
ZIP *
2017 U.S. Masters Swimming (USMS) Club/Team Affiliation
Club/Team (Maximum of 5 alphanumeric characters)
Club/Team Name
Member Number use all 10 digits, i.e. 3348-0000A
Register for USMS | Retrieve USMS Number
Emergency Contact (Parent, Spouse, etc)
Name *   Relation
Phone *
Name 2 *   Relation 2
Phone 2 *
(New members receive 50% discount for 1st month. Select rate, discount will be applied before billing)
(Family members living in the same household receive 25% discount)
(Person who referred you will receive a free BWAQ latex cap.)
Additional Information
Trial Workout Information
Date Attend (mm/dd/yyyy)
Facility attend Covington Aquatic Center, Covington
Evergreen Pool, Seattle
Federal Way Community Center, Federal Way
King County Aquatic Center, Federal Way
other

Problem with this registration?

Powered by ClubAssistant.com   ©2003-2017   Page execution time: 306 ms