NAME | | AGE | | ||
---|---|---|---|---|---|
TELEPHONE NUMBER | | ||||
ADDRESS | | ||||
CITY | | STATE | | ZIP CODE | |
HIGH SCHOOL | | GRADE (last completed) | | ||
USA Swim CLUB | | USS# | |
CUMULATIVE GRADE POINT AVERAGE |
Guidance Counselor's Signature (If required) | ||
---|---|---|---|
EVENT STANDARD AVERAGE | LIST MINIMUM OF 5 - REQUIRED. INDICATE SC (YARDS) OR LC (METERS). |
EVENTS: | | ||||
---|---|---|---|---|---|
TIMES: | | ||||
STANDARD: | |
| | |
Swimming Coach's Signature | Athlete's Signature | Date Submitted |
SEND COMPLETED APPLICATION WITH REPORT CARD TO: | Dave DiNardo 6018 North 20th Street
| Arlington, VA 22205
| 301-255-0765 (day)
| dave.dinardo@gmail.com
| |