Parent Payment Agreement and Payment Contract

1 Swimmer s Name: _____ Parent s Name: _____ Parent Payment Agreement and Payment Contract I have read and agree to the above membership and program fees: Parent /Guardian Signature_____ Date: _____/_____/_____ I agree to pay all Waldo County YMCA membership Fees and other charges invoiced to me in connection with such membership , including any special or additional assessments. The total Payment or first installment is due upon registration. All Bluefish swimmers must be Annual members in good standing with the Waldo County YMCA. Final Payment must be made by December 31st of the current swim season.

2 Please Check Your Payment Preference In The Appropriate Box Below _____ Please Check Here If your swimmer or your family has an existing Annual membership and your membership fee s are auto drafted monthly. If paying in three installments, the remaining payments are due in November and December of the current swim season. I acknowledge that non- Payment of membership or failure to meet membership requirements will result in swimmer being unable to participate in swim meets and practices. Please Initial Here Acknowledging Your Agreement To Pay All membership Dues: _____ I understand that the Bluefish Program Fee may be paid in full or in three installments.

3 The final balance will be paid off by December 31, 2016 for your swimmer to continue participating. Payment in Full -or- the total sum of the first monthly installment must be made at registration: ___ Green Group 1 (Mon & Wed) ___ In full - $217 ___ 3 payments : $85, $66, and $66 ___ Green Group 2 (Tues & Thurs) ___ In full - $217 ___ 3 payments : $85, $66, and $66 ___ Red Group (3x-5x week) ___ In full - $292 ___ 3 payments : $98, $97, and $97 ___ Blue Group (5x week) ___ In full - $334 ___ 3 payments : $116, $109, $109 ___ High School ___ In full - $140 ___ 3 payments : $68, $36, & $36 **If your family has multiple swimmers, please take advantage of our multiple swimmer discount.

4 The highest rated swimmer pays full tuition and all additional swimmers receive a $ discount from their program fee** Returning Member ___ In full - $168 __ Three installments of $80, $48, and $40 First Time Member ___ In full - $183 (includes one time joiner fee) __ Three installments of $92, $51, and $40 Registering for USA Swimming? Please complete the Front and Back of this registration form and sign the Back Side of this Payment Agreement at the time of Registration. For Front Desk Use Only: Total membership Fee & Program Fee Due at Time of Registration For this Swimmer: $ I have read and agree to the above membership fees, Bluefish Program fees, and USA Swimming Registration and Meet Fees: Parent /Guardian Signature_____ Date: _____/_____/_____ For Front Desk Use Only: Total membership Fee + Program Fee + USA Swimming Fee That Is Due at Time of Registration For This Swimmer.

5 $ USA SWIMMING REGISTRATION (This program is optional) I agree to pay all USA Swimming Fees and other charges invoiced to me in connection with such membership , including registration fees, travel fee, and meet fees. USA Swimming Registration must be paid in full at the time of registering for USA swimming. Bluefish Swimmers who register for USA Swimming will be able to compete in Meets Year round thanks to the addition of our Bluefish Summer Swim program. You can choose to be a Seasonal or Annual member with USA swimming. Please Check Which USA Swimming membership Option Is Right For Your Swimmer: Be sure to check with the coaches to see what would be the best choice for your swimmer, Swimmers can register for USA swimming at any time during the season.

6 The majority of the USA swimming registration fee goes straight to USA swimming to register your swimmer. The additional fees help to offset the cost of our coaches travel expenses and time attending these USA Meets, but does not cover these expenses. The remainder of these travel fees are covered by team fundraising and the Aquatics budget of the Waldo County YMCA. In registering for USA swimming I agree to pay all Event fees prior to each swim meet my child registers for. The coach will inform parents of the fees due or they will be displayed when you sign up for the meet online.

7 Payment must be made for those events prior to the meet. If a swimmer registers for a meet and does not attend for any reason, he/she is still responsible for those event fees. All event fees need to be paid in advance at our Front Desk. _____$70 = Seasonal membership This fee includes a $50 Registration Fee + $25 Travel Fee Choose this option if you only plan to swim USA October April/May. _____ $95 = Annual membership This fee Includes $ Annual Registration fee & a $25 Travel Fee Choose this option if you plan to swim in USA meets year round.

8 This option includes a subscription to Splash Magazine