Surveypoint

Q1

Full Name

First Name

Q2

Full Name

Last Name

Q3

Age

Q4

Date of Birth

Date

Q5

Gender

M

F

Q6

Phone Number

Q7

Email

Q8

Address

Street Address

Q9

Address

Street Address Line 2

Q10

Address

City

Q11

Address

State / Province

Q12

Address

Postal / Zip Code

Q13

Emergency Contact Person

First Name

Q14

Emergency Contact Person

Last Name

Q15

Emergency Person Phone Number

Phone Number

Q16

Relationship to Emergency Contact Person

Q17

Payment Method

Cash

Credit Card

Check

PayPal

Q18

Registration Fee

10 years old and under$15.00

15 years old and under$25.00

1500 Meter$50.00

3500 Meter$60.00

Q19

Participant's Signature

Q20

Date Signed

Date

Q21

Swimming Race Template 2 -Form Fill

Full Name

Full Name

Age

Date of Birth

Gender

Phone Number

Email

Address

Address

Address

Address

Address

Emergency Contact Person

Emergency Contact Person

Emergency Person Phone Number

Relationship to Emergency Contact Person

Payment Method

Registration Fee

Participant's Signature

Date Signed

Parent/Guardian Signature (If below 16 years old)