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CHRISTUS Swim

2020-2021 Swim Season

2020-2021 Swim Season Flex Athlete Registration Application

Name*
First Middle Last
Preferred Name
Date of Birth*
Date Format: MM slash DD slash YYYY
Sex*
- M
- F
Age
Club Code
Name of Club You Represent
NOTE: If you are 18 years of age or older, you are required to abide by to the Minor Athlete Abuse Prevention Policy. In addition, in order to be a member in good standing you must complete the Athlete Protection Training. The training can be accessed at www.usaswimming.org/apt
Guardian #1 Name*
First Last
Guardian #2 Name
First Last
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Telehpone No.*
Family/Household Email Address*
Member's Email Address*
US Citizen:*
- Yes
- No
Are you a member of another FINA organization?*
- Yes
- No
Have you represented that federation at international competition?*
- Yes
- No
Optional
Disability
- Legally Blind or Visually Impaired
- Deaf or Hard of Hearing
- Physical Disability such as amputation, cerebral palsy, dwarfism, spinal injury, mobility impairment
- Cognitive Disability such as severe learning disorder, autism
Race and Ethnicity
- Black or African American
- Asian
- White
- Hispanic or Latino
- American Indian & Alaska Native
- Some Other Race
- Native Hawaiian & Other Pacific Islander
Check up to two choices
High School Students: Year of high school graduation:
Last year registered:
If you registered with a different USA Swimming club in 2020, enter that club code:
LSC Code:
And the date of your last competition representing that club:

Save the Date

10/02/21

Miracle Tour 2021

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CHRISTUS Foundation — Shreveport-Bossier

7591 Fern Avenue, Suite 1903 • Shreveport, LA 71105

(318) 681-6781 • fax (318) 798-8317

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