Columbus Eagles Swim Team (EST)
OHIO’S ULTIMATE TECHNIQUE STROKE ANALYSIS CAMPS
Last Name First Name Middle Name
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Street Address City State Zip
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Telephone E- Mail
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Birth Date Age Sex
Please Circle Camp(s)!
No Camps Scheduled At This Time
Cost per camp
TBD
Total Amount Due: $_______ (Checks made payable to Eagles Swim Team)
Please describe medical conditions or other problems that may affect swimming (e.g. asthma, etc.): __________________________________________________________
Parent/Guardians
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Father's Name Mother's Name
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Father's Address (if different from above) Mother’s Address (if different from above)
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Father's Telephone Mother's Telephone
If parents cannot be reached please notify: __________________________________________________________________________
Relationship Name Phone
This is a registration for the OHIO’S ULTIMATE TECHNIQUE STROKE ANALYSIS CAMP, which is owned and operated by Eaglez Aquatic INC and Eagles Swim Team. I agree to abide by the Constitution, Rules, By-Laws, Decisions and interpretations of the EST organization, it's coaching staff, and The Columbus North Athletic club (“CNAC”). I grant permission for the EST Coaching Staff to authorize any necessary medical attention to the above named swimmer in my absence. I also grant the EST Coaching Staff disciplinary authority in my absence. I hereby give my consent for the above named swimmer to engage in camps training sessions. I release the EST, Eaglez Aquatic INC., and all the officers, employees, agents and CNAC of any and all liability for any youngster's personal health due to no physical examination prior to participation. EST reserves the right to limit the number of participants and the times at which they may practice. All participants must turn in a complete application with proper fee payments.
Date______________________
Parent/Guardian Signature_____________________________________
Mail to EST * P.O. Box 26661 * Columbus OH 43226 Questions? Call Head Coach, Sam Fattah (740) 816-2039 or contact him at eaglezswim@aol.com. Team website www.eaglezswim.com