Central Columbia Aquatic Club

2009 Summer Registration Form

Come join the 7th season of the CCAC Age Group Swim Team! This is a great opportunity
for all swimmers ages 5
-
18 to improve their swimming skills. Be a member of the
competitive swim program and form friendships that last a lifetime.
Our goal is to
have a healthy, safe and fun activity for all swimmers in our school district.

Mail to:

CCAC c/o Shawnna Lupini,

609 Mifflin-Nescopeck Hwy
Nescopeck, PA 18635

Or put in the “Lupini” file folder on the pool deck.

** Please make checks payable to CCAC **

Questions can be directed to Mr. LaCroix at 683-5693.

COST: One Child $95.00/ Two Children -$180.00 / Three Children $250.00

**** CCAC HAS A NO REFUND POLICY ****

Parent/Guardian Names: ______

Address: _______

Phone: E-Mail Address: _______________________

1.) Swimmer Name ______________________________

Birthdate: ______

T-shirt size: _________________________________

2.) Swimmer Name

Birthdate:

T-shirt size: __________________________________

3.) Swimmer Name __________________________

Birthdate:

T-shirt size: __________________________________

_________I give permission to the CCAC organization to publicize my swimmer(s) photo and/or name in publications.

Parent/Guardian Signature ____________________________________________________

**** PRACTICES FOR THE SUMMER SEASON WILL BEGIN ON MONDAY, MAY 4TH ****

Middle/High School Swimmers 2:30-4:00 ~ Elementary School Swimmers 4:00-5:00

Registration Deadline:

Friday, May 8th!!