2022-2023 Fall/Winter CST Season Enrollment Form

WEST COOK YMCA COMPETITIVE SWIM TEAM 2022-2023 FALL/WINTER SHORT COURSE SEASON ENROLLMENT FORM
Welcome to the West Cook YMCA Competitive Swim Team for the 2022-2023 Fall/Winter Short Course Season! Swimmers are required to be members of the West Cook YMCA as well as USA swimming to be a part of the Competitive Swim Team, this season registration form includes options to register for and sign up for needed memberships to finalize registration for the season.

For more details about the season please visit our website landing page www.westcookymca.org/cst. If you have any questions please email us at cst-team@westcookymca.org.

Parent/Guardian Information
Parent/Guardian Name: *

First Name Middle Name Last Name Suffix
Parent/Guardian Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian Phone Number *

Area Code Phone Number
Parent/Guardian Email *
example@example.com
Additional Emails to include on team communications (please include first and last name and email)

Emergency Contact Information

We will only contact emergency contacts in a case in which parent/guardians are not available.
Emergency Contact *

First Name Middle Name Last Name Suffix
Emergency Contact Relation *
Emergency Contact Primary Phone *

Area Code Phone Number

Membership, ISI Fees, and Parent Agreement
Membership Options- must have a card on file with the West Cook YMCA or will be contacted for payment information. *

Yes, our swimmer and/or family has a membership I would like to upgrade to a household membership ($89/month) I would like to have our swimmer(s) to have a youth membership for each swimmer ($27/month) Our family would like to have a household membership ($89/month) I do not know if my membership is active, if not, please reactivate
Parent/Guardian certifies that the applicant(s) is (are) physically able to participate in competitive swimming and/or clinic programming, and parent/guardian is in agreement with the rules governing the program, including rules pertaining to personal behavior and conduct of the swimmer(s). Parent/Guardian understands that swimmers dismissed as a result of rules violations are not entitled to refunds. Parent/Guardian authorizes the West Cook YMCA to activate swim team billing including ISI fee (if applicable and is not paid through this form) and membership options as chosen above and charge my card on file. *

Clear
Date *

Month Day Year
Date

WEST COOK YMCA COMPETITIVE SWIM TEAM 2022-2023 FALL/WINTER SHORT COURSE SEASON ENROLLMENT FORM