PLEASE PRINT OR TYPE!!!

I give permission for my son/daughter to participate in the swim-meet taking place on ___________________________known as the ____________________________________meet.

My swimmer's name, (First Name)________________ Middle____ Last Name__________________

his/her birth-date is_________________ which makes him/her______years old for the swim meet.

Parent Signature____________________________________________________________________

Fill Out Using the meet Information!!!

                                              Cost of each entry________Mutiply by the number of entries______=_________

                                                                                                                               Zone surcharge __________

                                                                                                                           Total Amount Due __________

If you are at the meet and it is possible to put relays together you will be put into a relay.  If you fail to participate in the relay, you will be responsible for paying for the relay and that a fine will be issued.

Please make checks payable to Berea Midpark Swim Club.  One check per family.  Please give entry forms to your GROUP COACH.