Swimmer Information
Please Print Full Name with Middle Initial!
Age on May 31, 2015

Name___________________Birthdate______________age______M/F

Name___________________Birthdate______________age______M/F

Name___________________Birthdate______________age______M/F

If you have a year round swimmer, please include their USSA ID#
________________________________________________

Parents Name_______________________________________________

Address/zip code________________________________________________

Home Phone_________________________cell_______________

e-mail_________________________________________________

Club Members	                                         Non Club Members
       						       
1st Swimmer… $125.00	                                     $140.00/pp
Each Additional Swimmer…$95.00

13-14 years…  $50
15-18 years…   No Charge

Rookie League….$105

Make Checks Payable to HAMPTON FARMS CLUB
If you are unable to make it to the registration, you can drop off your completed registration form at
The Schads 4940 Riverhill Road
Please Contact Holly Schad with any questions
770-853-3887
See ya at the Pool!