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Neshaminy CORE Swimming

Red USA
Registration & Fee Schedule
Brian Suter Team Director
neshswim@yahoo.com
2011-2012 Season
Sept 26 , 2011 March(JOs/Nationals)
th

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
Senior CORE

Amount Due
$585.00

Discount

Amt. Paid

5%

$_________

(If paid in full by 10/3/11)

Subtotal

$_________

USA Registration

$65.00

N/A

$_________

Volunteer Fee (Separate Check)

$50.00

N/A

$__________

(One per family Refundable upon completion.


Of SAL Volunteer Assignment)

Total Amount Due

$700.00

$670.00
(If paid in full by 10/3/11)

** Make check payable to CORE Swimming


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

$_________

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