Neshaminy CORE Swimming

Red CORE-Non USA

Registration & Fee Schedule
Brian Suter - Team Director
neshswim@yahoo.com
2011-2012 Season
September 26th, 2011 February 4th (Last SAL Meet)
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
Junior CORE

Amount Due
$435.00

Discount

Amt. Paid

5%

$_________

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

Volunteer Fee (Separate Check)

$50.00

N/A

$__________

(One per family Refundable upon completion.

Of SAL Volunteer Assignment)

Total Amount Due

$485.00

$465.00
(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.

$_________