Application

Name:           Telephone #:   

Social Security #:         Date of Birth:          Age:   

Address:         City:   

State:         Zip Code:          Community:    

Current School Attending:          Current Grade:   

College Phone # (if different):    

E-mail Address:

School you will be attending next year:   

Sex:    Male Female    Boys Shorts Size:   N/A Small Medium Large X-Large     T-Shirt Size:    Small Medium Large X-Large XX-Large

Girls' Suit Size:   N/A 28 30 32 34 36 38 40     Girls Shorts Size:   N/A Small Medium Large X-Large   Suit Type:    N/A One-Piece Two-Piece      

Current Certifications:		Expiration Dates:
Lifeguard Training, ARC, or Equivalent	Yes No
County Pool Operators Permit	Yes No
CPR (community), ARC or equivalent	Yes No
Other: