Wheeling YMCA Cardinal Aquatics Swim Team Registration Information 2016-17 Season Child/Swimmers Name: Middle Initial Gender Age (age on or after Dec. 1, 2016) Date of Birth / / Grade: School: Address: City State Zip Home Phone: Cell phone: Parent or Guardian Name(s): Address (if different from above): Home Phone (if different from above) Cell Phone E-Mail address (Please print early) (used for your swimming account) Please check One: I will obtain a membership through the Wheeling YMCA Cardinal Aquatics Team. I will be billed $205 for individual and will pay this by October 1, 2015. Checks written to WHY Cardinal Aquatics. Please put in payment box or give to Stephanie Fogle or a board member during sign ups. Please get a Y registration card and fill this out and we will turn this in to the
YMCA on your behalf. (It helps the team if you get a membership through us and you enjoy the same great benefits at the YMCA.) I currently have or will obtain a membership directly through the YMCA Expiration Date: / / Please provide a copy of your card to the team. Memberships are verified with the YMCA annually. I will renew with the swim team and pay $205 per child. Checks payable to the team and your account will be updated from the expiration date through the following year. You may pay this before your card expires. If your membership card expires in the fall please pay as soon as possible (October through November). If it expires in January or later please pay be January- March. Thanks! If you are a US Swimmer, please complete the following: US Number: Expiration date: / / I will renew at $73 per swimmer. I will not renew. This check is also made out the WhY Cardinal Aquatics and the head coach renews them as a team. You should get your cards by January as they expire in December. Enclosed is my payment. I will pay at a later date. This will be Due in December.
Emergency Consent Information Child/Swimmers Name: Parent/Guardian name(s) and place of Employment: 1. 2. Phone: Phone: Cell Phone: Cell Phone: Friend or relative who will assume temporary care of your child if you cannot be reached: Name Relationship to swimmer: Address: Phone: Cell Phone: MEDICAL INFORMATION (MUST BE COMPLETED) Swimmers Physician: Physicians hone Preferred Hospital Health Ins. Carrier Policy Holder s Name Policy # Health Information: Please list any pertinent health conditions or chronic condition that your child may have: Medication your child is taking for any of the above conditions: ** To the parent: Feel free to inform the coach if there a medical concern with your swimmer.
My child has had a physical in the past 12 months : Date: / / I authorize the coaches or parent officers of the Wheeling YMCA Cardinal Aquatics Swim Team to contact person(s) named on this paper and authorized named physician(s) to render such treatment as may be deemed necessary in an emergency. In the event person(s) named above cannot be contacted, Swim Team coaches and parent officers are authorized to take whatever action is deemed necessary in their judgment for the health of the above-named child. I will not hold the Wheeling YMCA Swim Team, its coaches or officers financially responsible for the emergency care and/or transportation of the above-named child. Parent/Guardian Signature: Date: Wheeling YMCA Cardinal Aquatics 2014-2015 Fees Schedule YMCA MEMBERSHIP IS REQUIRED REGARDLESS OF SWIMMERS AGE, Please read below YMCA individual membership cost $205.00 You must submit payment by 10/1/14 if the team is obtaining your membership. All swimmers whether competing or not are required to be a member to swim with the team and be covered by insurance. High school only swimmers are included as well. A family membership can be purchased if you wish. A family membership is $605.00. *If you have a corporate membership please turn in a copy of the swimmers membership card. *If you have a comp pass from the YMCA, please submit a copy of the Card ASAP *If you have a card and pay through the Y bank (monthly), please submit a copy of the swimmers card The team must have a copy of the current carrent card by October 1, 2016.
Swimmer(s) name Parent acknowledgement Team Fees: $400 for one swimmer, $380 for each additional (final payment by end of December) (Minimum $100 payments or $100 each and one of $80). **If Paid in Full by Sept. 29 th, $370 for one swimmer, $350 for each additional Initial DELINQUENT ACCOUNTS: Accounts that are 15 days past the due date will be suspended. What this means is that you will not be able to enter the swimmer in any meets until the amount is caught up and the swimmer cannot practice. Also, delinquent accounts from the past year will not longer be eligible for the payment plan and will have to pay all registration and Y fees up front and meet fees will need to be paid in full on a monthly basis. Any apparel purchased will have to be paid prior to the order being placed for those individuals. Account Balances: Accounts should not carry more than a $100 balance after January 1, 2015. Questions: Stephanie Fogle, Treasurer at 304-639-6262 Initial
*****PARENT PARTICIPATION: Swim meets rely on parent participation in order to run smoothly. Please understand there are swim meets that we will expect parents to work and will usually have sign ups for jobs in advance. 4 points will be required and jobs at home meets. There will be a sign up on line. If you have trouble getting points please inquire on what you can do to help later in the year. Four credits will be required and you will be charged $30 for each point on your account and then you will be credited $30 for each shift worked as the season progresses.