2012 DAM Re-Enrollment

All members must re-enroll and renew their PacMasters Card by December 31, 2011.
Re-enrollment can be completed online with this form, or by printing this form out and placing it in the box at Civic Pool.
PacMasters card/registration can be done online here.

Personal Information

First Name*

Last Name*

Address*

City*

Zip*

Email Address

Check if you want your email
shown in the DAM Roster*

Phone Number

Check if you want your phone
number shown in the DAM Roster*

Birthday MM-DD-YY
- -

Emergency Contact Information

Emergency Contact Name*

Emergency Contact Phone*

Emergency Contact Address

Physician

Health Plan

Do you have any medical
concerns our coaches should
be aware of?

Workout Choice; Leave; Dual Memberships

Workout Choice*

Workouts are filled with swimmers having
the lowest priority numbers. If the workout
you choose is full you will be listed as "Unassigned".

If a workout is full, swimmers assigned to a workout
are given priority over those who are assigned to
another workout, or who are "Unassigned".

Arroyo 5:45AM
Civic 6:00AM
Civic 7:00AM
Civic 10:00AM (55+ given priority)
Civic 11:00AM
Civic 12:00PM
Civic 1:00PM
Civic 6:15PM
Civic 7:15PM
Unassigned

Are you on leave?

If on leave, what is the month/year of your
estimated return date?

Are you a member of Peak Performance?

Are you a member of Physical Edge?