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:_______________
