"North Carolina Swimming Athlete Certification Template" - North Carolina

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Download "North Carolina Swimming Athlete Certification Template" - North Carolina

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FOR NEW ATHLETE REGISTRATION ONLY
North Carolina Swimming Athlete Certification
It is essential for North Carolina Swimming to have accurate information for each new athlete
member during the registration process. Please complete the information below and return it to your
Coach. Registration for new athlete members will not be complete until this form is provided to the
North Carolina Registrar. Please clearly print the following information.
Name: ____________________ _____________________ __________________
First
Middle
Last
Preferred Name:
_______________________________________
Date of Birth: ____________________
month/year/date
I hereby certify that the information provided on this form is true and correct. I understand that
providing false information subjects the athlete to discipline under the North Carolina Code of
Conduct and the USA Swimming Code of Conduct. I further agree to provide additional
documentation if requested to confirm this information.
Print - Parent or Guardian
___________________________
Date:
Signature - Parent or Guardian ___________________________
Date:
FOR NEW ATHLETE REGISTRATION ONLY
North Carolina Swimming Athlete Certification
It is essential for North Carolina Swimming to have accurate information for each new athlete
member during the registration process. Please complete the information below and return it to your
Coach. Registration for new athlete members will not be complete until this form is provided to the
North Carolina Registrar. Please clearly print the following information.
Name: ____________________ _____________________ __________________
First
Middle
Last
Preferred Name:
_______________________________________
Date of Birth: ____________________
month/year/date
I hereby certify that the information provided on this form is true and correct. I understand that
providing false information subjects the athlete to discipline under the North Carolina Code of
Conduct and the USA Swimming Code of Conduct. I further agree to provide additional
documentation if requested to confirm this information.
Print - Parent or Guardian
___________________________
Date:
Signature - Parent or Guardian ___________________________
Date: