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201-402-4103131 NJ-17, Hasbrouck Heights, NJ 07604

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Swim & Dive Team

Swim & Dive Team Registration below

Please complete the form below to register your child or children for Swim Team, Dive Team or Both

"*" indicates required fields

Parent's Name*

First Last

Parent's Phone*

Parent's Email*

Address*

Street Address Address Line 2 City State ZIP Code

Child 1

Child 1 Name*

First Last

Child 1 Date of Birth*

MM slash DD slash YYYY

Child 1*

Swim Team

Dive Team

Both Teams

Subtotal

$0.00

Are you registering another child?*

Yes

Child 2

Child 2 Name

First Last

Child 2 Date of Birth

MM slash DD slash YYYY

Child 2*

Swim Team

Dive Team

Both Teams

Subtotal

$0.00

Are you registering a third child?

Yes

Child 3

Child 3 Name

First Last

Child 3 Date of Birth

MM slash DD slash YYYY

Child 3*

Swim Team

Dive Team

Both Teams

Subtotal

$0.00

Payment

Please select the sessions below that you are paying for across all children registered above.

Order Total

Credit Card*

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

CAPTCHA

Order Token

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For more than 50 years, The Hasbrouck Heights Swim Club has been a place for families and guests to enjoy during the summer months. Our club is open to residents of surrounding towns.

131 NJ-17, Hasbrouck Heights, NJ 07604

201-402-4103

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