C’ ya’ll! Masters at Crossgates
Adult Swim Fitness Program Registration Form
FALL 2010
September 7 – November 18

Name (Last First): __________________________________ Age: ________

Home Phone: __________________ Work: ______________ Cell: ______

Address: (please include zip code): _____________________________________________________________

Email Address: please write legibly

_____________________________________________________________

Please list any health implications: _____________________________________________________________

Emergency Contact Name and Number: ____________________________________________________________

Fall 2010

Crossgates Members: $79.00

Non-members: $109.00

Swim fees include swimming as much or as little as you would like.

(Coach Cece recommends swimming at least 2 days a week.)

Paid by:
Check #/amt ______ or Cash/amt ______ or Charge _____ Date pd ____

After completing the registration form in full - turn over take a minute to read and sign. Turn in form with your payment at the front desk of

Cross Gates Family Fitness Military rd or Pontchartrain locations.

Thank you and Coach Cece looks forward to seeing you in the pool!