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Athlete Information

First Name:*

Last Name:*

Middle Initial:

Preferred Name:

Age:*

Age Group:*

12 Years or Younger

12 Years or Older

Birthdate:*

Gender:*

Male

Female

Height:*Feet: Inches:

Weight:*

Swim Suit Size:*

Males- size around waist; Females- size around chest.

Shoe Size:*

Current School:*

Grade:*

GPA:*

Emergency Contact Information

Emergency Contact Name 1:

Emergency Contact Phone Number 1:

Emergency Contact Name 2:

Emergency Contact Phone Number 2:

Medical Information

Doctor’s Name:*

Medical Conditions:

Medication:

Doctor’s Phone Number:*

Allergies:

Physical Limitations/Considerations:

Swimming Experience

Member of HLHK Learn 2 Swim?:*

Yes

No

Other swim experience:

How’d you hear about us:

Parent/Guardian Information

Parent/Guardian First Name:*

Parent/Guardian Last Name:*

Do you live with this parent/guardian?:*

Yes

No

Parent/Guardian Address 1:*

Parent/Guardian Address 2:

Parent/Guardian City:*

Parent/Guardian State:*

Parent/Guardian Zip:*

Parent/Guardian Home/Cell Phone Number:*

Parent/Guardian Email:*

Cc: This is someone else’s email address. Invite this person to be Cc’d on your messages. Handy for spouses, parents, guardians, and more.Add: This is a secondary email address. Add this address to your account. It will receive all email messages sent to your account. The address must be confirmed before it will be listed in your account settings.Ignore: Don’t do anything with this address.

Parent/Guardian 2 First Name:

Parent/Guardian 2 Last Name:

Do you live with this parent/guardian?:

Yes

No

Parent/Guardian 2 Address 1:

Parent/Guardian 2 Address 2:

Parent/Guardian 2 City:

Parent/Guardian 2 State:

Parent/Guardian 2 Zip:

Parent/Guardian 2 Home/Cell Phone Number:

Parent/Guardian 2 Email:

USA Swimming Athlete Application

USA Swimming Athlete Application Upload:

You will have an opportunity to register additional family members/participants on the Review page.

WELCOME TO THE 2016-2017 HLHK SEALS REGISTRATION.

Family Discount

Questions?

Constance –

SportsEngine Registration: Healthy Lifestyle Healthy Kids