BBAF Submission Form - Palo Alto Swim

Name of Participant*

First Last

Gender*

Current Age*

Grade in school next fall*

School to be attended next fall*

Which programs would you be interested in?*

Parent/Guardian Information

Name of Parent/Guardian*

First Last

Home Phone or Cell Phone Number*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian Email Address*

How many individuals live in your household?*

*Required Information

Combined household income for the last 12 months:*

**Required information. See diagram below for further explanation. Enter combined income OR color.

Would you be willing to share your story with us?*

Consent*

Checking this box states that all of the above statements are true