Summer Swim / Dive Team Registration Parent 1 Name(Required) First Last Parent 1 Phone(Required)Parent 1 Email(Required) Parent 2 Name First Last Parent 2 PhoneParent 2 Email Swimmer / Diver Registration Child Name Child Gender Child Date of Birth Child’s Age as of June 1, 2026 Registering this child for swim team, dive team, or both? Child 1 T-Shirt Size Actions Edit Delete There are no Entries. Add Child Maximum number of entries reached. Consent(Required)I consent to use of my child’s photo on our teams’ facebook and instragram pages, which are private and administered by the Penn Brook Aquatics Director. YesNoCost(Required)Member Swim Team OnlyMember Dive Team OnlyMember Swim and Dive TeamNon-Member Swim Team OnlyNon-Member Dive Team OnlyNon-Member Swim and Dive TeamQuantity(Required)Total Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name CAPTCHAThis field is hidden when viewing the formSwimmer / Diver Name First Last This field is hidden when viewing the formSwimmer / Diver T-shirt sizeFirst ChoiceSecond ChoiceThird ChoiceOrder Token
