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COPPER MEMBERSHIP REGISTRATION AND PAYMENT CONTRACT
This form must be filled out online, downloaded and signed, and then mailed to:
SWAT 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, 2019. AFTER SEPTEMBER 24th, 2019 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_____ ($1250) SC ONLY ($750) _____
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 SWAT website as to what meets and days they would like their swimmer to participate in by posted deadline.
YEARLY MEMBERSHIP: DUE @ registration: $450. MINIMUM MONTHLY PAYMENTS : $80 (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: $450. MINIMUM. MONTHLY PAYMENTS : $50 ( 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 SWAT Membership I have registered for on this form. I grant permission for my child’s picture to be on SWAT website Yes___ NO___. I qualify for the ____________________ discount, in the amount _________.
SIGNATURE OF PARENT/GUARDIAN: ____________________________________________ DATE___________
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