Neshaminy CORE Swimming

SAL/ High School Prep

Registration & Fee Schedule
Brian Suter CORE Team Coach
neshswim@yahoo.com
2011-2012 Season
September 26th, 2011 February 4, 2012(SAL Champs)
Childs Name: __________________________________ Birthdate: __________________ M/F_____
Address:________________________________________________________________________
City: ________________________________________

State:________

Zipcode: ____________

Mother:________________________ Phone Number: ________________ Cell Number: ______________

Father: ________________________ Phone Number: _________________ Cell Number: ______________
Family Contact Email Address: _____________________________________________________________
Medical Problems/Allergies: ________________________________________________________________
Emergency Contact: ____________________________ Emergency Phone:___________________
Family Physician: ______________________________ Physician Phone: _____________________

Fees
Program

Amount Due

Discount

Amt. Paid

High School/USA

$160.00

N/A

$_________

Volunteer Fee (Separate Check)

$50.00

N/A

$__________

(One per family Refundable upon completion.

Of SAL Volunteer Assignment)

Total Amount Due

$210.00

** Make check payable to CORE Swimming

*** No refunds will be given after October 14th. Refunds are subject to a $50 processing fee.

$_________