CHELTENHAM AQUATIC CLUB SUMMER SESSION 2012

Child’s name (first-middle-last) (circle Male /Female) Date of Birth

1. ______M / F DOB ______

2. ______M / F DOB ______

Parent/Guardian Name(s)______

Address______

City ______State _____ Zip Code______

Home Phone ( ) ______Work Phone ( ) ______

E-mail Address______

Name of school that your child attends______

REFUND POLICY: The fee for becoming a member of the Cheltenham Aquatic Club is for the season regardless of any scheduled or unscheduled pool closings due to unforeseen circumstances. No refunds will be made after the second week that the pool opens for the season. Requests for refunds made during the first two weeks must be submitted in writing to CAC and 90% of the fee, minus any sums of money paid out by the team on the individual’s behalf (e.g. t-shirts, membership in USA Swimming) will be returned. Refund requests will not be accepted after the second week of the swim season except for medical reasons. A request for a medical reason must be submitted in writing to CAC along with a note from the physician. Upon approval by the Board, a prorated refund, less the fees noted above, will be returned.

I hereby authorize the staff of the Cheltenham Aquatic Club to act for me according to their best judgment in any emergency requiring medical attention. I hereby waive and release the Cheltenham Aquatic Club from any and all liability for any injuries or illnesses incurred while with the Cheltenham Aquatic Club. I have no knowledge of any physical impairment that would be affected by my child’s participation in the Cheltenham Aquatic Club's swim program. In addition, I have read and fully understand the refund policy as described above.

Date ______

Parent or Guardian Signature______

2010 CAC Summer Session Fees

1.

Bronze & Silver Groups

______$75 for 3 weeks - June 4th - June 22nd , 3x a week (M, T, TH)

OR

______$160 for 8 weeks – June 4th – July 27th, 3x a week (M, T, TH)

Gold & Elite Groups

______$125 for 3 weeks – June 4 th - June 22nd ,4x a week (M, T, W, TH)

OR

______$205 for 8 weeks – June 4 th – July 27th 4x a week thru June 22nd

(M, T, W, TH) then 3x a week for remainder of session (M, T, TH)

______

2.

______$60 for Swimmers Not Previously Registered For 2011/12 Must Pay USS Registration Fee

(fee covers USA swimming insurance and subscription to Splash magazine)

______

3.

Weekly sessions are available beginning week 4:

$35 per week for Gold & Elite

$30 per week for Bronze & Silver

If you are registering per week, please check the weeks you will be swimming:

_____Week 4—June 25-June 29

_____Week 5—July 2-July 5

_____Week 6—July 9-July 12

_____Week 7—July 16-July 19

_____Week 8—July 23-July 26

______= Total for per week option

______

______=Grand Total (add 3 sections above)

Please make check payable to: Cheltenham Aquatic Club or "CAC"