Clone of Prineville Swim Team Registration Form

Prineville Swim Team Registration Form

2026 Seasonal Registration
Have you registered your swimmer with USA Swimming for the upcoming season?

YesNo
Mom's Name

First NameLast Name
Mom's Email
example@example.com
Mom's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Dad's Name

First NameLast Name
Dad's Email
example@example.com
Dad's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
1) Swimmer's Name

First NameLast Name
Swimmer's Gender*

MaleFemale
Swimmer's Date of Birth*

MonthDayYear
Date
Swimmer's Age*
Swimsuit Size (sizing kit available)
Sweatshirt Size
Swimmers Preferred Name on Apparel
Shoe Size
Please indicate Youth/Adult (Example: Adult 7.5)
Swimmer Level:

Beginner - $250.00 feeIntermediate - $300.00 feeAdvanced - $300.00 feeTrial Swimmer - no fee at this time
2) Swimmer's Name

First NameLast Name
Swimmer's Gender

MaleFemale
Swimmer's Date of Birth

MonthDayYear
Date
Swimmer's Age
Swimsuit Size (sizing kit available)
Sweatshirt Size
Swimmers Preferred Name on Apparel
Shoe Size
Please indicate Youth/Adult (Example: Adult 7.5)
Swimmer Level:

Beginner - $250.00 feeIntermediate - $300.00 feeAdvanced - $300.00 feeTrial Swimmer - no fee at this time
3) Swimmer's Name

First NameLast Name
Swimmer's Gender

MaleFemale
Swimmer's Date of Birth

MonthDayYear
Date
Swimmer's Age
Swimsuit Size (sizing kit available)
Sweatshirt Size
Swimmers Preferred Name on Apparel
Shoe Size
Please indicate Youth/Adult (Example: Adult 7.5)
Swimmer Level:

Beginner - $250.00 feeIntermediate - $300.00 feeAdvanced - $300.00 feeTrial Swimmer - no fee at this time
4) Swimmer's Name

First NameLast Name
Swimmer's Gender

MaleFemale
Swimmer's Date of Birth

MonthDayYear
Date
Swimmer's Age
Swimsuit Size (sizing kit available)
Sweatshirt Size
Swimmers Preferred Name on Apparel
Shoe Size
Please indicate Youth/Adult (Example: Adult 7.5)
Swimmer Level:

Beginner - $250.00 feeIntermediate - $300.00 feeAdvanced - $300.00 feeTrial Swimmer - no fee at this time
5) Swimmer's Name

First NameLast Name
Swimmer's Gender

MaleFemale
Swimmer's Date of Birth

MonthDayYear
Date
Swimmer's Age
Swimsuit Size (sizing kit available)
Sweatshirt Size
Swimmers Preferred Name on Apparel
Shoe Size
Please indicate Youth/Adult (Example: Adult 7.5)
Swimmer Level:

Beginner - $250.00 feeIntermediate - $300.00 feeAdvanced - $300.00 feeTrial Swimmer - no fee at this time
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact
Name & Phone Number
Please click yes if you will give permission to have photographs of your child taken for social media purposes

YesNo
How did you find us?

Returning SwimmerFacebookFriendOther
If you were referred by a friend, please let us know who, so we can thank them!

First NameLast Name
We offer a $25.00 discount per child for families with multiple swimmers!

THIS ONLY APPLIES TO INTERMEDIATE & ADVANCED SWIMMERS. NOT AVAILABLE FOR BEGINNERS. - IF YOU WOULD LIKE TO TAKE ADVANTAGE OF THE SIBLING DISCOUNT, PLEASE PLAN TO PAY IN PERSON AT ONE OF OUR REGISTRATION EVENTS.
There is a 3% fee for online payments

(You may pay with cash or check at one of our in-person registration events for no fee)

My Products - Only select if you are paying online.

Beginner

$250.00 Quantity

Intermediate

$300.00 Quantity

Advanced

$300.00 Quantity

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

Payment Method:*

I'm paying the full balance for my swimmer(s) via online transactionI plan to pay with cash or check to avoid the feeI would like to set up payment arrangements
Please verify that you are human*

Parent Acknowledgement*

Rows	Yes/Agree
I understand I am required to volunteer at least 5 hours during the home swim meets
I understand my swimmer may NOT participate in any swim meets until his/her swim dues are paid in full
I understand PST will NOT order any swim gear for my swimmer until his/her swim dues are paid in full

Signature
Should be Empty:

Prineville Swim Team Registration Form

We offer a $25.00 discount per child for families with multiple swimmers!

There is a 3% fee for online payments

Credit Card