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Richland Swim Club P.O. Box 116 Gibsonia, PA 15044

Phone: 724-443-5221

SWIM TEAM PARTICIPATION FORM 2011 Complete and return with payment to the above address ­ Please indicate: '11 Swim Team in Memo The first meeting (informational) for the Richland Rays will be held on SATURDAY, MAY 28th from 10:00- 11:00 am *** It is mandatory for a parent of swimmers to attend this meeting. *** Meet the 2011 Richland Rays coaches and get information about the upcoming season. The cost for the 2011 season will be: $60.00 for the first child and $40.00 for each additional child. With a family maximum of $130 per household. This year each swimmer will be provided with a swim cap. Please mail payment to the above address. If you are new this season, or need a new Rays team suit please mark the following box so we can make arrangements to fill your needs. Knabe's will be at the club with suits, goggles, etc. for purchase T-Shirts and Hoodies with the RAYS logo will be available again this year. Order forms will be available shortly PLEASE MARK YOUR CALENDAR FOR THE ABOVE DATES!!! SWIMMERS NAME (First, Last) AGE COST

Total Number of Children Signed Up: _____

TOTAL PAYMENT: ___________________ CHECK NUMBER: ____________________

Swim Team Emergency Contact Information ­ (Please Print) FAMILY LAST NAME: _________________________________________________________________ Address: ______________________________________________ ______________________________________________________ Father: _______________________ Mother _______________________

Email Address: _________________________________________________________________________ Home Phone: _________________ Cell Phone: ________________ Work Phone: _______________


Microsoft Word - 2011 Swim Team Sign Up NS

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