2010-11

Student Name                                                                                    ________________

                   (Include first, middle, and last names as it appears on birth certificate.)

School____________________ Grade (fall)_____ E-mail___________________ _______

Address_________________________________________________________________           City____________________________________________Zip________________

Home #______________ Student cell#______________ Birthday___________________

Parent Name (1) _______________________________ Cell #______________________

     Employment________________________________ Work #_____________________

Parent Name (2) _______________________________ Cell #______________________

     Employment________________________________ Work #_____________________

Parent’s E-mail: ___________________________________________________________

Shirt Size__________    Short Size___________   Sweatshirt/Jacket Size_____________

                (Use YL, S, M, L, XL, or XXL.)

Bathing Suit Size______________    Jammer or Brief?  (Boys only—circle one.)

Have you ever tried out for the MHS swim team before? ____________When? _________

# of seasons on the team prior to 2010_________# of varsity letters earned_____________

School attended 2009-10: ___________________________________________________

DO NOT WRITE BELOW THIS LINE

1.      Birth Certificate (new)______(on file)______                                                        

2.      Athletic Insurance ($36)______                             

3.      SCHSL Physical form dated after April 1, 2010_______

4.      GHS Consent for Medical Treatment Form________

5.      MHS Extra-Curricular Responsibility Acknowledgement Form_______

6.      Student Vehicle Use Form_______

7.      Risk Acknowledgement Form (video)_______

8.      Academically Eligible