decatur family ymca gators swim team
DECATUR FAMILY YMCA 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
Primary Email Secondary 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 Monthly Program fees: Beginner – $55 monthly/autopay on the 1st of every month/$20 season fee for cap & shirt Intermediate 1 & 2 - $65 monthly/autopay on the 1st of every month/$20 fee for cap & shirt
Advanced Group - $70 monthly/autopay on the 1st of every month/$20 fee for cap & shirt
* 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
Primary Email Secondary 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 Monthly Program fees: Beginner – $55 monthly/autopay on the 1st of every month/$20 season fee for cap & shirt Intermediate 1 & 2 - $65 monthly/autopay on the 1st of every month/$20 fee for cap & shirt
Advanced Group - $70 monthly/autopay on the 1st of every month/$20 fee for cap & shirt
* 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**
