decatur family y-dsc- gators swim team Simple Storage
DECATUR FAMILY Y-DSC- GATORS SWIM TEAM Please complete a form for each swimmer Date
Swimmer’s Last
First
MI
Preferred Name
DOB
Age
Father’s Last
First
Mother’s Last
First
Mailing Address City
State
Zip
Home Phone Father’s Work Phone
Father’s Cell
Mother’s Work Phone
Mother’s Cell
Father’s Email Mother’s Email
Swimmer’s T-Shirt Size: YS
YM
YL
S
M
circle one
L
XL
XXL
Important Payment Information Please complete this form and give to front desk Child Name 1 Practice Group
Beginner
Int1
Int2
Adv.
circle correct group
Beginner
Int1
Int2
Adv.
circle correct group
Beginner
Int1
Int2
Adv.
circle correct group
Child Name 2 Practice Group Child Name 3 Practice Group Select Form of Payment: Select one:
Visa
Mastercard
Discover
Name as it appears on card
Billing Address City
State
Zip
Card Number Card Expiration Date All swim team members are required to register for the YMCA swim team and may also register for USA Swimming Monthly Program fees: Beginner – $45 monthly/autopay on the 1st of every month; 2nd child-$39.50; 3rd child-$36 Intermediate 1 - $65 monthly/autopay on the 1st of every month; 2nd child-$54; 3rd child-$48 Intermediate 2 - $70 monthly/autopay on the 1st of every month; 2nd child-$63; 3rd child-$56 Advanced Group - $85 monthly/autopay on the 1st of every month; 2nd child-$76.50; 3rd child-$68
USA Swimming Registration Fee: $75 per athlete
* Registration form will not be processed without parent signature and proof of payment*. Register by phone or in person at the Member Service Desk.
I understand that I am responsible for all fees and that failure to have fees paid will result in my swimmer(s) being unable to participate in any Swim Team activity, including practice, until they are paid in full. Parent Signature:
Date:
For questions please contact, Lori Manning, Aquatics Director or Alex Kralman/Laura Hutchins, Team Coaches @ [email protected] or [email protected]
**for front desk or office - please make copy of this form to place in swim team mail box**
Swimmer’s Last
First
MI
Preferred Name
DOB
Age
Father’s Last
First
Mother’s Last
First
Mailing Address City
State
Zip
Home Phone Father’s Work Phone
Father’s Cell
Mother’s Work Phone
Mother’s Cell
Father’s Email Mother’s Email
Swimmer’s T-Shirt Size: YS
YM
YL
S
M
circle one
L
XL
XXL
Important Payment Information Please complete this form and give to front desk Child Name 1 Practice Group
Beginner
Int1
Int2
Adv.
circle correct group
Beginner
Int1
Int2
Adv.
circle correct group
Beginner
Int1
Int2
Adv.
circle correct group
Child Name 2 Practice Group Child Name 3 Practice Group Select Form of Payment: Select one:
Visa
Mastercard
Discover
Name as it appears on card
Billing Address City
State
Zip
Card Number Card Expiration Date All swim team members are required to register for the YMCA swim team and may also register for USA Swimming Monthly Program fees: Beginner – $45 monthly/autopay on the 1st of every month; 2nd child-$39.50; 3rd child-$36 Intermediate 1 - $65 monthly/autopay on the 1st of every month; 2nd child-$54; 3rd child-$48 Intermediate 2 - $70 monthly/autopay on the 1st of every month; 2nd child-$63; 3rd child-$56 Advanced Group - $85 monthly/autopay on the 1st of every month; 2nd child-$76.50; 3rd child-$68
USA Swimming Registration Fee: $75 per athlete
* Registration form will not be processed without parent signature and proof of payment*. Register by phone or in person at the Member Service Desk.
I understand that I am responsible for all fees and that failure to have fees paid will result in my swimmer(s) being unable to participate in any Swim Team activity, including practice, until they are paid in full. Parent Signature:
Date:
For questions please contact, Lori Manning, Aquatics Director or Alex Kralman/Laura Hutchins, Team Coaches @ [email protected] or [email protected]
**for front desk or office - please make copy of this form to place in swim team mail box**
