EmailMeForm
BNSC SWIMMER REGISTRATION
Congratulations on your decision to join our family! Complete this form to start your 2 Week FREE TRIAL and get connected with all that BNSC has to offer.
Swimmer Information
First Name
*
Mid Name
*
Last Name
*
Preferred Name
Enter only if different than First Name
Birthdate
*
MM
/
DD
/
YYYY
Gender
*
Female
Male
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Swimmer Email
Email Notification List
Yes
No
Swimmer Cell Phone
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How did you hear of BNSC?
If applicable, what swim team did your child swim with prior to BNSC?
What is your swimmer's favorite stroke and/or event? If applicable, what is their best time for their favorite event.
Please guess which training level your swimmer might fit best into.
*
Please select
Stroke Development
Age Group 1
Age Group 2
Junior Varsity
Senior Varsity
Elite
I have no idea
1st Guardian Information
Name
*
First
Last
Home Phone
*
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Home phone number is required by USA swimming to register your swimmer. Please enter a number that you want them to use.
Cell Phone
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Email
*
This email address will be used for billing.
Email Notification List
*
Yes
No
Relationship
*
Please select
Father
Mother
Grand parent
Guardian
2nd Guardian Information
Name
First
Last
Cell Phone
###
-
###
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Email
Email Notification List
Yes
No
Relationship
Please select
Father
Mother
Grand parent
Guardian
Medical Information
Medical Conditions
Medication
Emergency Contact
Please include someone NOT listed on this form, such as a Grandparent, neighbor or good family friend.
Emergency Contact Phone
###
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Dr. Name
Dr. Phone
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Illinois Swimming membership
*
Yes
No
Are you currently registered with Illinois Swimming? Memberships are required and will be billed a nonrefundable $77 Illinois Swimming membership fee.
Family Directory
*
Yes
No
BNSC regularly updates a parent directory, so families can reach each other. This directory is posted password protected on our website. I give permission for my information to be shared in the directory
Photography
*
Yes
No
Occasionally, the opportunity will arise that photos may be taken of your child at Swimming Activities. These photos would be used for website, Facebook, local publications and etc. I give permission for photos of my child to be taken and used for the above stated purposes.
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