| 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
| |