Swim/Dive Team Registration

2026 Swim & Dive Team Registration

"*" indicates required fields

Date*

MM slash DD slash YYYY

Parent Name*

First Last

Parent Phone*

Parent Email*

Address*

Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code

Medical Information & Release Form

Mother's Name*

First Last

Mother's Phone*

Father's Name*

First Last

Father's Phone*

Emergency Contact Name*

First Last

Emergency Contact Phone*

Child's Physician's Name*

First Last

Child's Physician's Phone*

Insurance Company and Policy Number*

Allergies and/or Medical Conditions*

Medications (list all)*

Consent*

I hereby grant consent to all health care providers to administer any necessary medical care as a result of injury/illness. This consent includes First Aid and transportation to/from health care providers.

Child 1 Information

Child #1 Name*

First Last

Child #1 Gender*

MaleFemale

Child #1 T-Shirt Size*

Youth SmallYouth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-Large

Child #1 Date of Birth*

MM slash DD slash YYYY

Child #1 Age as of June 1, 2026*

345678910111213141516171819

Child #1 Membership Status*

Member

Non-Member

Is Child #1 a Lifeguard or Swim/Dive Coach?*

Yes

No

Child #1 Registering For:*

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only

Child #1 Registering For:*

Swim & Dive

Swim Only

Dive Only

Junior Dolphins - Swim & Dive

Junior Dolphins - Swim Only

Junior Dolphins - Dive Only

Lifeguard/Swim/Dive Coach - Swim & Dive*

Price:

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only*

Price:

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only*

Price:

Lifeguard/Swim/Dive Coach - Dive Only

Swim & Dive*

Price:

Swim & Dive

Swim & Dive*

Price:

Swim & Dive

Swim Only*

Price:

Swim Only

Swim Only*

Price:

Swim Only

Dive Only*

Price:

Dive Only

Dive Only*

Price:

Dive Only

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Add a 2nd child?*

Yes

No

Child 2 Information

Child #2 Name*

First Last

Child #2 Gender*

MaleFemale

Child #2 T-Shirt Size*

Youth SmallYouth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-Large

Child #2 Date of Birth*

MM slash DD slash YYYY

Child #2 Age as of June 1, 2026*

345678910111213141516171819

Child #2 Membership Status*

Member

Non-Member

Is Child #2 a Lifeguard or Swim/Dive Coach?*

Yes

No

Child #2 Registering For:*

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only

Child #2 Registering For:*

Swim & Dive

Swim Only

Dive Only

Junior Dolphins - Swim & Dive

Junior Dolphins - Swim Only

Junior Dolphins - Dive Only

Lifeguard/Swim/Dive Coach - Swim & Dive*

Price:

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only*

Price:

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only*

Price:

Lifeguard/Swim/Dive Coach - Dive Only

Swim & Dive*

Price:

Swim & Dive

Swim & Dive*

Price:

Swim & Dive

Swim Only*

Price:

Swim Only

Swim Only*

Price:

Swim Only

Dive Only*

Price:

Dive Only

Dive Only*

Price:

Dive Only

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Add a 3rd child?*

Yes

No

Child 3 Information

Child #3 Name*

First Last

Child #3 Gender*

MaleFemale

Child #3 T-Shirt Size*

Youth SmallYouth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-Large

Child #3 Date of Birth*

MM slash DD slash YYYY

Child #3 Age as of June 1, 2026*

345678910111213141516171819

Child #3 Membership Status*

Member

Non-Member

Is Child #3 a Lifeguard or Swim/Dive Coach?*

Yes

No

Child #3 Registering For:*

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only

Child #3 Registering For:*

Swim & Dive

Swim Only

Dive Only

Junior Dolphins - Swim & Dive

Junior Dolphins - Swim Only

Junior Dolphins - Dive Only

Lifeguard/Swim/Dive Coach - Swim & Dive*

Price:

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only*

Price:

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only*

Price:

Lifeguard/Swim/Dive Coach - Dive Only

Swim & Dive*

Price:

Swim & Dive

Swim & Dive*

Price:

Swim & Dive

Swim Only*

Price:

Swim Only

Swim Only*

Price:

Swim Only

Dive Only*

Price:

Dive Only

Dive Only*

Price:

Dive Only

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Add a 4th child?*

Yes

No

Child 4 Information

Child #4 Name*

First Last

Child #4 Gender*

MaleFemale

Child #4 T-Shirt Size*

Youth SmallYouth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-Large

Child #4 Date of Birth*

MM slash DD slash YYYY

Child #4 Age as of June 1, 2026*

345678910111213141516171819

Child #4 Membership Status*

Member

Non-Member

Is Child #4 a Lifeguard or Swim/Dive Coach?*

Yes

No

Child #4 Registering For:*

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only

Child #4 Registering For:*

Swim & Dive

Swim Only

Dive Only

Junior Dolphins - Swim & Dive

Junior Dolphins - Swim Only

Junior Dolphins - Dive Only

Lifeguard/Swim/Dive Coach - Swim & Dive*

Price:

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only*

Price:

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only*

Price:

Lifeguard/Swim/Dive Coach - Dive Only

Swim & Dive*

Price:

Swim & Dive

Swim & Dive*

Price:

Swim & Dive

Swim Only*

Price:

Swim Only

Swim Only*

Price:

Swim Only

Dive Only*

Price:

Dive Only

Dive Only*

Price:

Dive Only

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Add a 5th child?*

Yes

No

Child 5 Information

Child #5 Name*

First Last

Child #5 Gender*

MaleFemale

Child #5 T-Shirt Size*

Youth SmallYouth MediumYouth LargeYouth X-LargeAdult SmallAdult MediumAdult LargeAdult X-Large

Child #5 Date of Birth*

MM slash DD slash YYYY

Child #5 Age as of June 1, 2026*

345678910111213141516171819

Child #5 Membership Status*

Member

Non-Member

Is Child #5 a Lifeguard or Swim/Dive Coach?*

Yes

No

Child #5 Registering For:*

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only

Child #5 Registering For:*

Swim & Dive

Swim Only

Dive Only

Junior Dolphins - Swim & Dive

Junior Dolphins - Swim Only

Junior Dolphins - Dive Only

Lifeguard/Swim/Dive Coach - Swim & Dive*

Price:

Lifeguard/Swim/Dive Coach - Swim & Dive

Lifeguard/Swim/Dive Coach - Swim Only*

Price:

Lifeguard/Swim/Dive Coach - Swim Only

Lifeguard/Swim/Dive Coach - Dive Only*

Price:

Lifeguard/Swim/Dive Coach - Dive Only

Swim & Dive*

Price:

Swim & Dive

Swim & Dive*

Price:

Swim & Dive

Swim Only*

Price:

Swim Only

Swim Only*

Price:

Swim Only

Dive Only*

Price:

Dive Only

Dive Only*

Price:

Dive Only

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim & Dive*

Price:

Junior Dolphins Swim & Dive

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Swim Only*

Price:

Junior Dolphins Swim Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Junior Dolphins Dive Only*

Price:

Junior Dolphins Dive Only

Payment Information

Discount Code

Discount

$0.00

Total

Work Bond Amount:

$100.00

(To be paid separately as a check to BFSC. All Work Bonds should be given to Todd Delinger or Amy Valentino. Work bonds are returned to parents after you fulfill your work bond duties. If you do not fulfill them during the swim/dive season, they will be cashed).

All Swim & Dive Registrations will be paid via Credit Card. Work Bonds will be paid by Check (which can be given to Todd Dellinger).*

Credit Card

Credit Card*

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date

Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045

  Security Code Cardholder Name

Please remember all work bonds must be paid by check to BFSC and given to the Front Desk Attn: Todd Dellinger on top of paying for swim and/or registration fees via credit card or via check.

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