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You are registering for
Hampden Aquatic Club 2012 Season
Registration Form created by
Bonne DuCharme
Athlete First Name
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Athlete Last name
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Athlete Email Address
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Athlete DOB mm/dd/yyyy
*
Athlete Gender
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Male
Female
Athlete Home Address (street, city, zip)
*
Athlete Cell Phone #
Parent Name #1
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Parent Email Address #1
*
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Parent Cell Phone #1
*
Parent Name #2
Parent Email Address #2
Parent Cell Phone #2
Athlete T-Shirt Size
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Small
Medium
Large
X-Large
XX-Large
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