Welcome to
The Derby Swim Club

The Derby Swim Club provides an opportunity for children of the Derby area community to participate in a competitive swimming program during the summer months. Swim practice with a coach is provided during the winter months.

Register and Pay

Online Registration and Payment is provided for your convenience. After you complete this registration form, you will be taken to another page where you may pay with one of the following OR a PayPal account:

Our secure online payment option is processed through PayPal. You do not need a PayPal account. Please read or print [complete instructions].

SUMMER SWIM Registration Form 2008
After completing this form, you will be taken to an online payment page
Registration is $100 for first swimmer, $75 for other family swimmers, Insurance is $27

Swimmer #1

Swimmer #2

Swimmer #3

Swimmers Name

Swimmers Birthday

Swimmer is

Male Female

Parents Email

Your Name

Other parents name

Street Address

City, State, Zip

Home Phone

Other Phone

I give permission for my children's photos to be posted on the web site: (initial if yes)
If you choose No, please notify a board member and the coaches.

Parental involvement is required. Please check ALL volunteer position(s) you will be involved with for the summer swim meet session:
	Starter or Recall Starter must complete the certification clinic and required USA Swimming exams	Stroke/Turn Judge must complete the certification clinic and required USA Swimming exams	Clerk of the course
	Timer	Head Timer	Place Judge
	Swim4FUNdz planning team	Runner	Ribbons
	Computer team	Announcer	Volunteer Coordinator