SUMMER 2007 EARLY BIRD SWIM - PROGRAM APPLICATION
Name_________________________________________________________________________
Address_______________________________________________________________________
Town___________________________ State __ Zip _______
Home Phone_________________
Email Address:
_____________________________________ Work Phone _________________ ________________________________ Work
Phone: ________________
Participation is
strictly at swimmers own risk. I am
in good health and to the best of my knowledge I do not have any physical
limitations that would prevent me from participating in this program. I
will update MRSC of any changes to my physical condition.
Signature:________________________________________Date:____________
