Swift Current Barracudas Swim Club
Registration Form
2015– 2016
Swimmer #1
Swimmer #2
Swimmer #3
Last Name
First Name
Sex M/F
Date of Birth (please print month)
Saskatchewan Health Care #
Age
Allergies / Concerns
(use additional paper if necessary)
Session Time
Olympic Way (please circle)
4-5
5-6
Olympic Way Bronze
Silver
Gold
Group (please circle)
4-5
5-6
Olympic Way Bronze
Silver
Gold
4-5
5-6
Olympic Way Bronze
Silver
Gold
Fee
Receipt Number
**E-mail address is needed for correspondence. If you do not use e-mail, please let us know.
EMAIL__________________________________________________________________________________________________
Guardians Name(s):____________________________________________________________________________
Swimmer’s Address:_______________________________________________________________________________
City:_____________________________________Province:_______________________Postal Code:_____________
Home phone:________________________Other Number(s):____________________________________________
Emergency contact person
Name:_________________________________________________________________________________________
Home phone:____________________________Other Number(s):_________________________________________
** Swim SK fees are set by the Swim Saskatchewan governing body and are required. These fees cover swimmer registration with Swim Canada
and Swim Saskatchewan and also provide insurance coverage to the club. The noncompetitive fee will cover one competitive/sanctioned swim meet
in a season before the swimmer must register as competitive in order to compete in a second swim meet.
Swimmer fees are non-refundable with the exception to the following;
Swimmers will have a trial period starting beginning of swim season, and ending December 31, 2015. If the swimmer does not wish to continue with
the club past December 31, notification needs to be made to the Registrar by December 1st in writing. At which time, fees will be prorated for months
remaining, and refunded. A $25.00 administration fee will be charged at that time. After December 31, 2015, swimming fees are non-refundable
with the exception of family relocation or a letter from a doctor or physiotherapist stating they are not medically fit to swim(this refund would also be
pro-rated) as per policy B1-d,e,f.
N.S.F. cheques will be charged $25.00
When you sign up at the beginning of the year, you will pick the program your child is going to swim. The swimmer cannot change to a different day
or time for the remainder of the season unless they are moving up to a new program. Any and all moves will be completed in consultation with the
Head Coach. Any difference in fees for switching programs will be pro-rated for the remainder of the season.
Parent/Guardian Signature _________________________
For Office use only
Date:
Amount Paid
Cheque/Cash
Deposit
Post-dated
Post-dated