2011-2012 Registration Forms

To view the Registration Package which details all the terms you are agreeing to, please download using the link below! In completing this online form you are agreeing to this entire program and its agreements:

CPWD Registration Package with Officials Info 2011 2012

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Please fill out the following form and submit:

Registration Form

We would love to hear from you! Please fill out this form and we will get in touch with you shortly.

Swimmer's Information
Swimmers Name
FirstLast
Address
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Gender
- Male
- Female
Date of Birth
MM
DD
YYYY
Swim Group
Please pick a swim group you are registering for.
Parent/Guardian Information
Father's Name
FirstLast
Father's Address (if different from swimmer)
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Home Phone
Cell Phone
Work Phone
Father's Email
Mother's Name
FirstLast
Mother's Address (if different than swimmer's)
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Home Phone
Cell Phone
Work Phone
Mother's Email
Contact email address for registration process
Medical Information
Health Card Number
Doctor's Name
FirstLast
Doctor's Phone
Dentist's Name
FirstLast
Dentist's Phone
Emergency Contact Name
FirstLast
Emergency Contact Home Phone
Emergency Contact Cell Phone
Emergency Contact Work Phone
Allergies
Please list all allergies
Does your child require medication?*
- Yes
- No
If yes, please describe type of medication and dosage required:
Agreement - Please confirm that you have read, understand, acknowledge and agree to the following:*
- The CPWD Waiver of Liability
- The Name and Photographic Release
- Club Phonebook Conditions
- PIPEDA Terms
- The CPWD Code of Conduct