Emergency Contact Information

Swimmer’s Name : _____________________________________________

Parents/Guardians Name: ________________________________________

________________________________________

Home Phone Number: __________________________________________

Cell Phone Numbers : __________________________________________

Other Phone (Specify) ___________________________________________

Emergency Contact: (other than parents/guardians)

Name: __________________________________________________

Relationship: ____________________________________________

Phone : ________________________________________

Cell Phone : ________________________________________

Medical Notification Information:

Doctor/Clinic Name: _______________________________________

Doctor’s Phone: __________________________________________

Preferred Hospital: ________________________________________

Allergies:

______________________________________________________