Campus Recreation On-Line Swim Registration

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Participant's First Name

Participant's Last Name

Age

Male Female

Parent or Guardian's Name (if under the age of 18)

Address:

E-mail

Phone Number

Special Instructions (i.e. pertinent medical history, siblings also in program, car pooling, etc)

Select Swim Level/Time Slot

Note: If you cannot find a particular class/level from the drop-down list, this class has been filled and there are no spots available. To be placed on the waiting list, please email Justin_Lawler@uml.edu

I understand that participating in the UMass Lowell Campus Recreation Swimming Program is purely voluntary and that neither the Department of Athletics nor the University of Massachusetts Lowell assumes the responsibility for any injury sustained through my or my child's participation. I am aware of the risk inherent in participation in this type of physical activity and agree that it is my responsibility to determine whether or not I or my child is physically fit to participate in this program.

Check here to acknowledge.

I DO NOT give UMass Lowell permission to use my child's picture in any marketing materials.

(Please initial)