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Choate Student Pre-Season Training

CHOATE STUDENT PRE-SEASON 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_____ ($1000)     SC ONLY ($600) _____ 

 

PAYMENT:  DUE IN FULL @ REGISTRATION. Please check preferred.

 

______  $300 ( without USA Swimming membership needed)

 

______  $375 ( with USA Swimming membership needed)

 

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___.

 

SIGNATURE OF PARENT/GUARDIAN: ____________________________________________ 

 

DATE___________