SwimAmerica Swimmers and/or Divers
Lottery Form for the Fall session

This form will be used only for the first session. You will need to register at the pool (at the Open Registration time) for any subsequent session(s).

Name ________________________________________________ Station __________________

Name ________________________________________________ Station __________________

Name ________________________________________________ Station __________________

Parents' Name(s) _______________________________________________________________________________

Daytime Phone ___________________     Alternate Contact Phone (cell) ______________________

Preference:

• M/W 6:00pm class ________ Swim Like a Fish (Pre-school) through #10
• M/W 6:45pm class ________ Swim Like a Fish (Pre-school) through #10
• T/Th 6:00pm class ________ Baby & Me/Swim Like a Fish through #5