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Silver Membership

 

SILVER MEMBERSHIP REGISTRATION AND PAYMENT CONTRACT

 

This form must be filled out online, downloaded and signed, and then mailed to: 

CCAT LLC , 470 Pool Rd, North Haven, CT 06473. Payments may be made with credit card online or by check to above address by required deadlines.  REFUNDS ARE ONLY PROVIDED UP TO SEPTEMBER 24th,  2018. AFTER  SEPTEMBER 24th, 2018  SIGNEE IS RESPONSIBLE FOR TOTAL FEE FOR REGISTERED MEMBERSHIP.

 

Swimmer Name: FIRST____________________    MI______   LAST____________________

 

Birthdate: ___/___/______   Current USA Swimming Member:  Yes____  No____

 

Parent Name: FIRST____________________   MI______   LAST____________________

 

Email Address:______________________________  Phone:____________________

 

Please list any medical issues/medications that coaches should be aware of:

 

 

 

 

(Attach any additional notes concerning medical issues that coaches should be aware of)

 

EMERGENCY CONTACT (Name & Phone):___________________________________________

 

EMERGENCY CONTACT (Name & Phone):___________________________________________

 

MEMBERSHIP:  Please check which GOLD MEMBERSHIP REGISTERING FOR: 

YEARLY_____ ($1500)     SC ONLY ($880) _____ 

 

PAYMENT:  Members can use monthly payment plan or pay additional amounts as desired.  MEET FEES WILL BE ADDED TO INDIVIDUAL INVOICES AND ARE DUE WITH MONTHLY PAYMENT AS INCURRED.  It is parent/guardian responsibility to decline or commit on the CCAT website as to what meets and days they would like their swimmer to participate in by posted deadline. 

 

YEARLY MEMBERSHIP:  DUE @ registration: $350. MINIMUM MONTHLY PAYMENTS : $115 (plus any meet fees). Payments must be made by 5th of each month October – July.  Invoices will be sent on first of each month. A $15 fee will be added for any and each failed credit card payments.

 

SC ONLY MEMBERSHIP:  DUE @ registration: $400. MINIMUM. MONTHLY PAYMENTS : $80 ( plus any meet fees). Payments must be made by 5th of each month October – March.   Invoices will be sent on first of each month. A $15 fee will be added for any and each failed credit card payments.

 

I understand and take responsibility of my financial obligations as listed above for the CCAT Membership I have registered for on this form.  I grant permission for my child’s picture to be on CCAT website Yes___ NO___. I qualify for the ____________________ discount, in the amount _________.

 

SIGNATURE OF PARENT/GUARDIAN: ____________________________________________  DATE___________