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BMAC Swim School
                   251-458-2628
Please call 251-458-2628 or email: BMACSwim@Yahoo.com to find out availability of classes before you send in registration. 
Mail To: Mrs. Carol Martin, 10155 Canal Circle, Fairhope, Alabama, 36532 
Fee: $130.00/8 classes 

Swimmer’s Name:__________________________________________________
Swimmer’s Birth Date:___________________Age________
Swimmer’s Address:________________________________________________
City:_________________________________zip:_________________________ Home Phone #:____________________________________________________
School Attends:____________________________________________________
Email Address: ____________________________________________________

Does child have any emotional/physical problems or medical conditions that we 
need to know about.  Please Explain:___________________________________
________________________________________________________________

Mother’s Name:__________________________________________________
Mother’s Home #:_______________________
Mother’s Cell #:_________________________
Mother’s Work#:________________________ 

Father’s Name:____________________________________________________
Father’s Home #:_______________________
Father’s Cell #:_________________________
Father’s Work#:________________________ 

Emergency Contact Person: Name:___________________________________________________________ Relation to Child:___________________________________________________
Address:_________________________________________________________
Cell#:____________Home#:_________________Work#:___________________ 

Registering for: 
Session #__________________________Time______________________

Office Use Only: Cash:__________________ Chk#:__________________ 
Date Paid:_______________