Performance Plus

Order Form

Dates and Costs
Week 1: August 11 - 15, 2008 : $295.00* + GST Week 2: August 18 - 22, 2008: $295.00* + GST *Prices in effect until June 1st, 2008.
Swimmer Information
First Name:
Last Name:
Date of Birth:
Age:
Gender:	Male Female
T-shirt Size:	SM MD LG XLG
Address:
Unit #:
City:
Province:
Postal Code:
Home Phone:
Email:
Medical Information
Provincial Health Card Number, Version Number:
Name of Family Doctor:
Phone number:
Allergies:
Life-threatening?
Medication instructions?
Date of Last Tetanus:
Parent/Guardian Information
First Name:
Last Name:
Phone:
Email:
Are there any other diet or health concerns we should be aware of?