2024 Swim Team Credit Card Use this form to sign up for Swim Team and pay with a credit card. "*" indicates required fields SWIMMER INFORMATIONSwimmer's Name* First Last Swimmer's Age as of May 15, 2024*Please enter a number from 5 to 18.Swimmer's Date Of Birth* MM slash DD slash YYYY New or Returning Swimmer* New Swimmer Returning Swimmer Swimmer's Gender Female Male Swimmer's Fin Size*Fins are a new training tool this year! If you have your own fins, please mark that option. I have my own fins Little Kid 1-2 Youth 3-4 / W 5 Youth 4-5 / W 6 M 5-6 / W 6-7 M 7-8 / W 8-9 M 8-9 / W 9-10 M 9-10 / W 10-11 M 11-12 / W 12-13 M 13-14 / W 14-15 POLICY AGREEMENTSUSAA Swimming Affiliation*I understand that, per CSSCSA rules, my swimmer can not participate in USAA Club swimming after May 15, 2024. (NoCo Swim Club, Loveland Swim Club, Eaton Red Waves, Wahoos Swim Club, for example). YES, I understand, and my swimmer is not participating in USAA Club swimming. General Liability Waiver*I release Kelly Farm Pool & Racquet Association including its board, employees, members, volunteers, and other agents from liability in case of accident, illness (including COVID-19), injury, cancellations, or any other unforeseen events. YES, I understand, and release Kelly Farm Pool & Racquet Association from liability. Volunteer Deposit*I understand the terms of the volunteer deposit, and that the volunteer deposit will ONLY be refunded after volunteering for a minimum number of events. (Number will be determined and communicated prior to the season starting – typically 2-3 meet shifts/jobs) The $85 volunteer deposit should be paid with a separate check or cash, and is due no later than Monday, June 3. YES, I agree to the terms of the Volunteer Deposit. Swim Meet Commitment*I understand that this swimmer needs to commit to swimming in a minimum of two (2) meets during the 2024 summer season. YES, my swimmer will participate in at least two meets this summer. Refund Statement*I understand that swim team registration fees are non-refundable, with one exception: If a swimmer attempts swim team, and coaches determine that they are not ready for swim team, the registration fees for that swimmer will be refunded, as will the volunteer deposit unless there are other swimmers in the family. YES, I agree to the refund statement CONTACT INFORMATIONParent/Guardian Names* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian Phone*Email*Make sure this is an email you check regularly, although the Band App will be our primary mode of communication. Additional Contact InformationProvide additional information as needed – is there a second phone number we should have on file in case of emergencies, a second email we should add to our list, etc.PAYMENTRegistration Fee*Membership status WILL be verified. If you haven’t paid your pool membership fee, please pay the Non-Member swim team fee. Class A or C Member – $120.00 Non-Member – $150.00 Swim Cap Order*The swim cap is our team “uniform” and is required for swim meets. Standard Team Cap – $16.00 Personalized Caps – $42.00 for two caps with identical personalization No thanks – I already have a team cap **ONLY ANSWER IF YOU SELECTED PERSONALIZED CAPSWhat personalization would you like on your caps? Select Method of Payment* Credit Card: Please fill out fields below – Debit Cards not accepted Subtotal $0.00 Credit Card Convenience FeeThis fee covers the cost of paying online by credit card. Price: $0.00 Total Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Security Code Cardholder Name CAPTCHA