WHITCHURCH-STOUFFVILLE SWIM CLUB 2015-2016 Season REGISTRATION Swimmer’s Name: ________________________________________ ______ M

□ F □ Date of Birth: (DD) ____ (MM) ____ (YY) ____ Age: _____

Address: ______________________________________________________ City: ______________________ ON, Postal Code: ________________ Parent/Guardian Name(s): (we use email as our main source of communication) Father: _____________________________ Home #: __________________ Cell #:__________________ Email: _____________________________

Mother: _____________________________Home #: __________________ Cell #:__________________ Email: _____________________________ Optional: Swimmer’s Cell #:_____________________________ Swimmer’s Email: ___________________________________________________

Family Doctor: _________________________________________________Phone #: ___________________________________________________ Medical conditions/information: _________________________________________ Medications (Inhaler/EPI etc):___________________________

Competitive Teams

Stroke Development/Competitive Fitness Groups

□ “A” Team (Mon/Tue/ Wed/Thurs.4:00-5:30 pm) + (Tue/Thurs/Sat. 6:00-7:30 am)

□ “B1” Team (Mon/ Wed.4:00-5:30 pm) + (Tue/Thurs/Sat. 6:00-7:30 am)

□ “B2” Team (Mon/ Wed.4-5:30 pm) + (Thurs/Sat. 6:00-7:30 am) Note: additional dryland training to be confirmed

□ Novice 1 (Wed. 4:00-4:30) □ Novice 2 (Wed. 4:30-5:00) □ Novice 3 (Wed. 5:00-5:30) □ Bronze (Mon. & Fri. 4:00-5:00) □ Silver (Tues. & Thurs. 4:00-5:30) □ Gold (Tues., Thurs. & Fri. 4:00-5:30)

New registrants: were you referred by one of our swimmers? If so, name: _________________________________________________________

DECLARATION:  I hereby make application for the above swimmer to be admitted as a Swimming Member of the Club subject to the policies and practices of the Club that are in effect from time to time.  I agree to the REFUND POLICY: On withdrawal, the swimmer will be charged for the number of months or part months that they have attended PLUS one month and there is no refund of Swim Ont. fees. Withdrawal begins on receipt of written notification. If withdrawal occurs within 2 weeks from registration, there will be a full refund less an Administration fee ($10/practice, minimum $50). There will be no refund of fees after December 31, 2015. After this date, any fees due for the remainder of the season will be payable in full upon withdrawal.  I agree to Home Meet Work Commitment (see Club Hosted Meets); NSF CHARGES of $30.00 and LATE PAYMENT CHARGES of $25.00. Any regular fees that are 30 days in arrears will result in the swimmer being denied access to practices, until the account is in good standing.  I understand that practice schedules and locations are subject to change at the discretion of the Head Coach, and that Club swimmers are required to wear the official Club uniform at competitions.  I give permission to enter and maintain required personal information on the Swimming Canada & Whitchurch-Stouffville Swim Club database for the purposes outlined in Swim Ontario’s policy. I authorize the chaperon, and/or coach(es) to take any action they deem necessary in an emergency.  I, the undersigned, do hereby release and agree to indemnify and save harmless the, Whitchurch-Stouffville Swim Club, Nick Rottmann, and their officers, employees or agents, and each and every Board and Commission thereof, from all claims for loss, injury or damage, to persons and property while participating in or traveling to and from Swim Club activities, which I, or any person claiming through me or my behalf, may at any time have arising out of or connected with the operation of this activity. SIGNATURE OF PARENT/GUARDIAN:_________________________________________________DATE:_____________________ Due to insurance requirements, this form MUST be completed before you are allowed to swim.

OFFICE USE ONLY PAYMENT TYPE: Cash □ Cheque □

PAYMENT PLAN: Full □ Quarterly □ Monthly □

S/O □

PAYMENT REC’D: Total: _____________ Cheque #’s: __________________________________________ REFERRAL: Name: ____________________________ Group: ___________ Credit Amount: $___________

WHITCHURCH-STOUFFVILLE SWIM CLUB 2015-2016 Season Parental Consent Form Photography and Website

Photography During the swim season (September to June) year there are occasions when photographs of your child may be taken by staff or parents of the Whitchurch-Stouffville Swim Club. Your authorization to use a photo or photos of your child in our publications (brochures, newsletters, website etc.) is requested.

Website - (Use of swimmers photographs/personal information) The Whitchurch-Stouffville Swim Club website (www.stouffvilleswimclub.com) is a tool used to highlight and celebrate your child’s accomplishments or participation in either the program or at swim meets, as well as promote our program. Group photos or action photos where swimmers cannot be identified may also be posted. Anyone with Internet access would be able to view pages from virtually anywhere in the world. If included, identification would be done by first name and first initial of last name only.

Consent I hereby authorize Whitchurch-Stouffville Swim Club to allow my child to be: Yes

No

Photographed Photos may be used on the: website/brochures/newsletters/FB Identifying information may be used: ( first name, last initial)

Swimmers Name(s) (please print): ________________________________

_______________________________

________________________________

_______________________________

Parent/guardian name: _________________________________________________

Signature: ___________________________________________ Date: ______________________________

--------------------------------------------------------------------------------------------------------------------------------------------------Office use only: Date received: _____________________________ Signed: _________________________

Personal Information Protection & Electronic Documents Act REGISTRATION CONSENT FORM – FOR USE BY SWIMMERS AND OFFICIALS Club Name

Whitchurch-Stouffville Swim Club

Registrant Name

Please Read Carefully; complete and sign this form. A Parent or Legal Guardian must sign for those registrants under the age of 18. The Federal Personal Information Protection & Electronic Documents Act (and equivalent provincial legislation) requires that consent be obtained prior to the collection and use of all personal information. The personal information you provide to the Club from this registration will be used for the purposes reasonably associated with the swimming activities conducted by the Club. These purposes include national, provincial and event registration, insurance coverage, training and competition participation and competition result publication. Some of the information you provide will be passed on to Swimming/Natation Canada (SNC) and Swim Ontario, for purposes including association registration, insurance coverage and: a) Ensuring swimmers train and compete in an age appropriate environment; b) Establishing athlete eligibility for selection to swim teams; c) Establishing pertinent medical records and baseline performance data to assist coaching decisions in a national team competitive or training setting; d) Reporting non-identifying, demographic and participation statistics to funders, sponsors and other authorized third parties; e) Reporting and publishing athletes’ name, gender, age, club affiliation on Swimming Canada web pages or in results, news releases and ranking reports and; f) Making direct contact with registrants, volunteers and staff as necessary for the operations of the Club, Swim Ontario and SNC. Swimming Canada complies with the obligation and responsibility to the World Anti-Doping Agency - WADA (or its agents) to provide information upon request. Additional personal information may be collected from time to time. Consent for the use of this personal information may be inferred where its uses are obvious and it has been voluntarily provided. When not obvious, the purposes for collection will be provided prior to, or at the time of collection; either orally or in writing. Complete texts of the Privacy/Personal Information Policies (variously the “Policy” or the “Policies”) may be found for SNC at: and for the Swim Ontario https://www.swimming.ca/Privacy at http://swimontario.com/userfiles/file/About%20Us/Policy%20and%20Procedure/SwimOntarioPolicies.pdf Should a registrant wish to review their personal information held by the Club, Swim Ontario, or SNC they must make a request to the appropriate organization pursuant to that organization’s Policy. Further, registrants may withdraw consent to use their personal information pursuant to the Policies. Such a withdrawal however, may require the cancellation of registration with and suspension of activities with the Club, Swim Ontario and SNC. All registrants or their legal guardian must sign a copy of this form each season. I hereby consent to the collection and use of personal information as described above.

Signature of Registrant (age 18 or older) or Parent/Guardian

Date

WHITCHURCH-STOUFFVILLE SWIM CLUB 2015-2016 Season Registration Fees

Please select your payment option to obtain the appropriate rates. The Non-refundable Swim Ontario (SO) fee must be added to your initial registration fee. Please see below for correct amount. PAYMENT IN FULL: “A” Team $3595 + SO Fee Gold $1930 + SO Fee “B1” Team $2690 + SO Fee Silver $1540 + SO Fee “B2” Team $2320 + SO Fee Bronze $ 940 + SO Fee Novice $ 420 + SO Fee QUARTERLY INSTALLMENTS: Installment payment dates are November 1, 2015, February 1, 2016 and April 1, 2016. “A” Team “B1” Team “B2” Team Gold Silver Bronze Novice

Upon Registration $912 + SO Fee Upon Registration $685 + SO Fee Upon Registration $594 + SO Fee Upon Registration $495 + SO Fee Upon Registration $398 + SO Fee Upon Registration $248 + SO Fee Upon Registration $120 + SO Fee

Plus 3 installments of $912 Plus 3 installments of $685 Plus 3 installments of $594 Plus 3 installments of $495 Plus 3 installments of $398 Plus 3 installments of $248 Plus 3 installments of $120

MONTHLY INSTALLMENTS: st First and last month’s dues are due upon registration. Remaining 8 months fees are due on the 1 of the month starting October 1, 2015. “A” Team “B1” Team “B2” Team Gold Silver

Upon Registration $736 + SO Fee Upon Registration $556 + SO Fee Upon Registration $480 + SO Fee Upon Registration $410 + SO Fee Upon Registration $330 + SO Fee

Plus 8 installments of $368 Plus 8 installments of $278 Plus 8 installments of $240 Plus 8 installments of $205 Plus 8 installments of $165 st

SWIM ONTARIO FEES - please use your child’s age as of December 31 , 2015.

Competitive – A & B Teams & Gold Group 8 years & under = $82.00 9-10 years = $102.00 11-14 years = $122.00 15 years & older = $142.00     

Silver, Bronze & Novice Groups = $44.00

Methods of payment accepted are Cash or Cheque. Post-dated for installments are DUE AT REGISTRATION. Cheques payable to: “WHITCHURCH-STOUFFVILLE SWIM CLUB” - “WSSC” is acceptable. Please see registration form for cancellation/refund/late payment policies. Please note that Holidays, practices off and cancelled practices have been reflected in our pricing. Administration fees for monthly and quarterly payment plans are included in the rates.

CLUB INCENTIVE - MEMBERSHIP REFERRAL With room to grow, we would like to encourage everyone to promote our club and to refer new swimmers. For the coming season we want to offer an incentive: For each swimmer referred we will credit $100 towards your Meet Fees (A, B, Gold); $50 (Bronze, Silver). The swimmer must remain with the club for a minimum of 5 months or the incentive will be reversed. If referrals are made with less than 5 months left in the current season, credit will be given if the referred swimmers renews in the following season, when a total of 5 months are completed. The new swimmer must put your name (or multiple names if sharing) in the’ referred by’ space of their registration form for you to get credit.

WHITCHURCH-STOUFFVILLE SWIM CLUB 2015-2016 Season Competitive Swimmers Meet Commitments & Fees 

Like last year, we will continue to work throughout the summer communicating with the various host clubs to try and submit early entries; however this is not a guarantee of actually getting into the meet.

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We understand that this type of pre-planning can be difficult for some families and late entries or pulling out at the last minute is proving to be quite the challenge administratively.

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Once we submit the swimmers entries and they are approved by the host club, we are expected to pay.

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We will notify you via email the date the fees are to be submitted by. Payment may be made by cash, cheque or email transfer to [email protected]

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If for whatever reason (illness, scheduling conflict etc.) occurs, you are still responsible for the meet fees.

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Meet Entries, Fees and packages are uploaded to the website as soon as we get them. It is your responsibility to monitor for updates to meet entries, fees & meet packages.

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Usernames and passwords for the Member Login on the website will remain the same. If you have not been issued one, please let us know.

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Please submit your meet commitments via email to [email protected], please put “Meet Commitments for: name of swimmer” in the subject line and list the meets you wish to participate in.