Riptide: Cub Run RecCenter 2008-2009 (to print, right-click this page and select print)
   
Please make checks payable to: Riptide Swim Team
 
Mail registration form and payment to:
Shandra Richardson
6712 Jackpin Place
Gainesville, VA  20155

 

 

FAMILY NAME

LAST NAME FIRST NAME
STREET CITY STATE ZIP
HOME PHONE FATHER WORK MOTHER WORK
FATHER CELLULAR MOTHER CELLULAR FAMILY EMAIL
EMERGENCY CONTACT EMERGENCY PHONE

SWIMMERS

LAST NAME SUMMER CLUB
FIRST NAME & MIDDLE INT. FOR EACH SWIMMER
1 2 3 4
DOB SEX AGE
DOB SEX AGE
DOB SEX AGE
DOB SEX AGE
T-Shirt Size: T-Shirt Size: T-Shirt Size: T-Shirt Size:
50 freestyle time:

100 IM time:

 50 freestyle time:

100 IM time:

 

 50 freestyle time:

100 IM time:

 

 50 freestyle time:

100 IM time:
WORKOUT DAYS & TIME:

 

 WORKOUT DAYS & TIME: WORKOUT DAYS & TIME: WORKOUT DAYS & TIME:

PAYMENT:  Non Refundable $55 registration fee for 1st swimmer, $40 for additional family members: $430 for 1 x a week, $735 for 2 x's a week , $780 for 1 hour 15 minutes 2 x's a week,  $1040 3 x's a week, $365 for 1 x a week Home-School Program (includes PVS membership, Team T-Shirt, Cap, and Car Magnet)

TOTAL AMOUNT FOR SWIMMER 1 TOTAL AMOUNT FOR SWIMMER 2 TOTAL AMOUNT FOR SWIMMER 3 TOTAL AMOUNT FOR SWIMMER 4

Payment Contract: Upon acceptance into any of the Riptide Swim Team programs, both my swimmer(s) and I agree to abide by all team rules. I understand that I am obligated to pay the full program fees as indicated.  I understand my child will be prohibited from taking part in any team practice, meet, or activity if I fail to make payments in a timely manner. 

TOTAL AMOUNT FOR FAMILY $ __________._____

Registration fee's are due upon registration and the remaining balance is due September 30th, 2008.:

   
X_____________________________________________________________________________________
Parent/Adult Signature Date