Pd. Regist. _____________ Pd. Monthly fee: ___________________ Group - ________________ SL _____________
Walton Waves
Last name _____________________First name_________________MI _____
Preferred Name_________________DOB_________ Age _____ M / F _____
Address ______________________________________ zip _______________
Parents Name ___________________________ Hm # __________________
mom cell ________________________ dad cell ________________________
Emergency # ___________________ email address ____________________
Have you swam on another USS swim team before other than with WW?
Name of team _______________________________ year _________
Medical Release & Information
Swimmer's Name(s) Allergies / Medications, Other info.
_______________________ - ________________________________________
_______________________ - ________________________________________
Insurance Company / Policy Number ______________ Insurance contact # __________
I, _____________________________ agree to release Youth Swimming, Inc., Walton Waves, Inc. , Emory at Oxford & Staff, from any responsibilty for property damage, illness, or injury incurred by my child at Emory at Oxford. I also agree to allow Yo Staff, or another authority to administer First Aide for my child, if necessary. I, the undersigned, will be responsible for any & all costs of medical attention and/or treatment.
Signed _________________________Date __________________
Please make checks payable to : Walton Waves If you have any further questions please call
770--843-7946 or 770-490-6401
You can mail registration form to:Walton Waves: PO Box 1537, Oxford GA 30054
Call 770-490-6401 for more information or visit our website: waltonwaves.net