• Central Bucks Aquatics Swim Coach Individual Training Sessions
    Pre‑Registration Form 

    PLEASE PRINT: 

    Child’s Legal Name (per birth certificate – must include middle initial):

    Last Name ______________________________________________________

    First Name ______________________________________________________

    Middle Initial (write “none” if no middle initial) ________________________

    Preferred name (nickname), if any: ____________________ 

    Child’s Date of Birth: ___________________ Gender: ___________________

    Parents’ Names: __________________________________________________

    E-Mail:______________________________________________________________ 

    Home Address:______________________________________________________ 

                                                                                                      _________________________________________________________

    Primary phone number:____________________________

    Child’s School & School District:__________________________________________

    Child’s School Grade:___________________________________________________

    Swimmer’s swim team/swim clinic experience (team/clinic name, when, how long):  ___________________________________________________________________

    ___________________________________________________________________

    Skills on which swimmer wants to work in training session(s):

    ___________________________________________________________________

    ___________________________________________________________________

     

    ***Please email this completed form to Heather Yim (heayim@cbsd.org) to request individual training session availability.***     

    v. 8/2021 Click here for PDF if needed to print.