@
Wed, Dec 31st from -

 
First Name(s): Last:
Address:
City: State: Zip:
Phone: Email:
Emergency contact info:
Age(s):
Level of swimming: beginner  intermediate  masters  multi-sport
Please identify one goal for the clinic
 
Cost: $ per person
# of participants: X $ Total Amount: $

Send check (payable to Aquatic Edge) and completed form to: