Swimmer's First Name : | |
Swimmer's Last Name : | |
Swimmer's Middle Name : | |
Date of Birth (MM/DD/YYYY) : | |
Address : | |
City : | |
State : | |
Zip Code : | |
Parent's Name : | |
Home Phone : | |
Cell Phone : | |
Work Phone : | |
Email : | |
Doctor's Name : | |
Doctor's Phone : | |
Medical Conditions : | |
Medications : | |
Allergies : | |
Pool : | |
Practice Group : | |
T-Shirt Size : | |
Additional Family Payment (AFP) requirements: You will be invoiced the full amount of your
AFP at the beginning of the year. The
schedule for meeting this financial obligation is: a minimum of $150 or 50% of
your AFP is due by January 31, 2011 and the remaining amount is due by June 1,
2011. Each family will be provided a
status of their account as the year progresses.
If you obtain credit in excess of the required AFP, all
of this excess credit will be added to your family’s account and fifty percent
(50%) will be added to the RAYS general account. Excess credit to a family’s account may not
result in a refund of monies previously paid and a family may not delay a payment
due in anticipation of future AFP credit.
When a family leaves the team, excess funds in the family’s account
gained via AFP will revert to the RAYS.
I understand and accept that risk of injury is possible while participating in
athletic activities. I authorize the RAYS Swim Team to act according to their
best judgment in any emergency requiring medical attention. I agree to
indemnify and hold harmless anyone associated with RAYS for all medical or
dental expenses incurred as a result of participation in swimming activities or
programs. I hereby acknowledge that RAYS Swim Team, its staff, officials or
representatives, cannot be held responsible for any injury to my son/daughter.
Before beginning an activity, it is recommended that athletes receive a sport
physical given by their doctor.
Your typed name acts as your signature, and is an acknowledgement of your
understanding of this entire document and of your commitment to adhere to the
provisions established herein.
|
Signature : | |
How did you hear about the RAYS? |
|
Family referral (please provide name) : | |
Current Memberships : |
|
| The RAYS have several committes that can use your help. Please eslect at least one committee you wsould like to help with this coming year.
|
|
|
Payment Plan : |
|
PLEASE PRINT A COPY OF THIS PAGE FOR YOUR RECORDS BEFORE CLICKING SUBMIT!
PLEASE SEND PAYMENT TO: RAYS P.O. BOX 866, STAFFORD, VA 22555-0866
|
