Kettering City Swim Team Registration
2013-2014 Season (9/1/13 – 8/31/14)
(Revised 7/22/13)
Parent / Guardian Information:
Parent(s)/Guardian(s):
Address:
City
State
Zip:
Home Phone:
Mother’s Cell Phone:
Father’s Cell Phone:
Mother’s Email:
Mother’s Occupation:
Father’s Occupation:
Father’s E-mail:
Two Phone Numbers for One-Call Contact: 1)
2)
Swimmer Information:
1st Swimmer’s Name: __________________________________________________________________
Group (Check one)
Bronze Silver
Gold
T-shirt size: YS/YM/YL/AS/AM/AL/AXL
nd
2 Swimmer’s Name: _________________________________________________________________
Group (Check one)
Bronze Silver
Gold T-shirt size: YS/YM/YL/AS/AM/AL/AXL
rd
3 Swimmer’s Name: _________________________________________________________________
Group (Check one)
Bronze Silver
Gold T-shirt size: YS/YM/YL/AS/AM/AL/AXL
th
4 Swimmer’s Name: _________________________________________________________________
Group (Check one)
Bronze
Silver
Gold
T-shirt size: YS/YM/YL/AS/AM/AL/AXL
Registration Fees:
Annual Dues: Paid in Full (less %10 discount) or 1st Monthly Payment
Family Registration Fee ($75 per family):
USA Swim Membership Fee ($60 per swimmer):
Awards/Social Fee ($50 per Swimmer):
Optional: Opt-Out for SCRIP fundraiser ($150):
Optional: Donation to the Margaret Hong Scholarship Fund
TOTAL DUE AT REGISTRATION:
Security Deposit Required – Separate check for $150/swimmer
Check #
AUTHORIZATION
I hereby give consent for my child(ren) to participate with Kettering City Swim Team (KCST). In consideration of being permitted to participate as a
member of the KCST, I hereby release, discharge and agree to hold harmless the KCST, and its coaches, members of the Board of Directors, its volunteers or
any employees, together with its successors and assigns, from any and all liability for injuries to property or person suffered as a result of participation as a
member of the KCST. I give the club authorization to apply for USA Swimming memberships for my child(ren).
I agree that it is the swimmers’, their parents/guardians’, or designated representatives’ responsibility to provide transportation to, from and during any
program of the KCST and that any transportation provided by representatives of KCST is not being provided on behalf of KCST, and is strictly voluntary on
the part of the person providing that transportation.
I agree to and will sign the following: Financial/Parent Participation Contract (on the reverse side of this form), Medical Release, Code of Conduct, and
Publicity Release (return one for each swimmer). I also have read and understand the 2013-2014 Fee Structure. I understand that all these forms constitute
a legally binding contract and KCST will take action to obtain funds owed to the team if not paid in a timely manner.
_______________________________________/________________________________ ____________________
SIGNATURE
RELATIONSHIP TO SWIMMER
DATE
Kettering City Swim Team Registration
2013-2014 Season (9/1/13 – 8/31/14)
(Revised 7/22/13)
KCST Parent Responsibilities Contract
The sport of swimming requires a great deal of parental involvement. The following information is provided to
ensure understanding of the support required to be part of the team.
Financial Obligations
I acknowledge that KCST is a year-round program and I am liable for the entire amount due to KCST, to include
registration fees, monthly dues, and minimum fundraising requirements, regardless of whether my swimmer
participates the entire year. Requests for exceptions to this policy will be presented in writing before the first
Monday of each month for the board’s consideration. I understand that failure to meet my financial obligations to
KCST will result in revocation of USA Swimming membership for my swimmer(s), ineligibility for membership on
any team affiliated with USA Swimming, and possible legal action taken to recoup amount owed to the team.
_____________(initials)
I understand participation in the two KCST fundraisers is mandatory; however, I have the option to “opt out” of
the SCRIP fundraiser at the beginning of the season and pay the annual requirement of $150 at registration. If I
“opt out” and then later decide to participate, I will be eligible for the 50% split returned to the family account
after reaching the $150 threshold rebate amount. I further understand any portion of the minimum pledge
amount of $150 per swimmer ($300 family maximum) for SPLASH-A-THON not raised by my swimmers will be
billed on the May invoice. _________(initials)
Volunteer Obligations
I understand that even if my swimmers do not participate in our home meets there is still a requirement for family
members to support the team by working sessions at the meets since all families benefit from the funds generated
by hosting home meets. I acknowledge my responsibility to either work the required number of sessions at each
home meet or to make arrangements in advance for a suitable replacement to work those sessions for me. I
understand that failure to make those arrangements in advance will result in a charge of $50 per session not
worked. _________(initials)
I understand that in addition to supporting the meets, parents must become involved in the various committees
necessary to run a successful team, and each family will be required to support one activity or event outside of the
three home meets. (Examples of tasks include helping organize team events, marketing and team publicity,
ordering spirit wear and awards, fundraising, etc. There are also opportunities to learn how to run our timing
and computer systems and to become certified as an official.) I acknowledge my responsibility to support the
team functions and understand that USA Swimming registration for my swimmer(s) will not be accomplished until
I sign up to support one activity or event. __________(initials)
As a requirement for membership in the Kettering City Swim Team, I agree to the above conditions:
Signature of Parent or Guardian
________________________________________________
Date: ______________
Signature of KCST Representative
________________________________________________
Date: ______________