Swim Team Information - Shenango Valley YMCA

SHENANGO VALLEY YMCA
SEA LIONS
2014-15
GENERAL INFORMATION
SHENANGO VALLEY YMCA
925 N. Hermitage Road, Hermitage, PA 16148
Phone: 724-981-6950; Fax: 724-981-6951
www.svymca.com
www.facebook.com/ShenangoValleyYMCA
www.twitter.com/sv_ymca
SHARON HIGH SCHOOL
SWIMMING POOL
1129 East State Street, Sharon, PA 16146
Phone: 724-983-4030
Our Mission: To put Christian principles into practice through programs that build healthy
spirit, mind and body for all.
Our Cause: The Y is a cause-driven organization dedicated to youth development, healthy
living and social responsibility. We utilize resources to help youth develop to their fullest
potential, provide health and wellness opportunities for people of all ages and abilities,
foster community and economic development, and serve as a valuable community asset to
ensure that everyone has the opportunity to learn, grow and thrive.
Our Values: Caring, Honesty, Respect and Responsibility. Our values our celebrated by staff
and members and provide a positive foundation for all Y programs and a healthy connection
with others.
Who We Are: There is no other organization quite like the Y . . . It’s a place where generations
gather together, little ones build skills and self-esteem, people connect while strengthening
body and mind, kids learn about teamwork and sportsmanship, and families spend quality
time together.
Yes, children learn to swim, kids have somewhere to go after school, and we teach about
healthy lifestyles, but the Y is so much more than that.
The Y is a place where kids find direction, families come together, and people rally to make a
difference. The Y . . . Where community comes together!
STAFF & OFFICERS
YMCA STAFF
YMCA CEO
Executive Assistant
Sports Manager
Joellen Arenas
Robert States
Richard Weber
[email protected]
[email protected]
SEA LIONS COACHES
Head Coach
Assistant Coach
Bruce Tomasello
Mark Cattron
[email protected]
SWIM TEAM OFFICERS
President
Vice President
Secretary
Treasurer
Dan Songer
Deborah Snyder
Jimmy Benton
Jennifer Levitt
IMPORTANT WEBSITES
Shenango Valley YMCA
Sea Lions Website
www.svymca.com
www.teamunify.com/Home.jsp?team=amsvy
National YMCA
YMCA National Swimming & Diving
Western PA YMCA Swim League
USA Swimming
www.ymca.net
www.ymcaswimminganddiving.org
www.wpysl.org
www.usaswimming.org
MEMBERSHIP & FEES
Memberships and Fees
All YMCA athletes must be full privilege members of the YMCA that they represent, as
established by the “Rules That Govern YMCA Competitive Sports”. According to these
rules, a YMCA member is a person, who, after due application, is enrolled by the
association, entitled to full privileges, activities and services of that association. This
means that the members of YMCA competitive teams must have annual full-privilege
memberships that entitle them to the same activities and services as all other annual
full-privilege members.
2014 Membership Rates
Membership Type
Youth (13 & Under)
Young Adult (14 - 23)
Adult
Single Parent Family
Family
Senior (65 & Over)
Annual Rate Full Pay
$62
$235
$355
$470
$570
$295
Monthly Draft
N/A
$23
$31
$42
$53
$27
There is a one-time enrollment fee of $25-$50 for all new members, or members whose
membership has lapsed more than 3 weeks.
Swim Team Fees
First child in family:
Additional child in family, when 1st child pays full rate:
$300
$150
Membership must be paid in full, and a minimum deposit of $100 toward swim team fees
must be paid before the first day of practice.
Membership must be paid in full at one time, unless enrolled as a single parent family or
family autodraft.
Swim Team Fees can be paid in monthly installments, via monthly drafts on the 25 th of each
month between April and September (6 months), or in 3 installments between September and
October. Swim Team fees must be paid in full by October 31st, 2014 to be eligible for
Districts.
Due to increasing costs for pool rentals and other expenses, additional charges and/or
fundraising requirements may be added to these fees.
Financial assistance scholarships are available thanks to the generous supporters of our Y.
Contact the front desk for information.
SHENANGO VALLEY
SEA LIONS SWIM TEAM
Registration Form 2014-2015
Team Fees and Payment Option- All swimmers MUST have a current membership in addition
____$300 payment in Full ($150.00 for each additional child in a family)
Payment Plan:
____$100 per swimmer is due before the first practice
____$150 per swimmer is due by September 31st
____$300 ($150 for each additional swimmer per family) must be paid in full by October 30th
____Monthly Auto draft: Monthly drafts from a checking/savings account or credit card on the 25th of each
month between April and September. Final Draft of any balance will be September 25th.
Swimmer Information
First Child’s Full Name:
T-Shirt Size (circle one) Y S(6-8) Y M(10-12) Y L(14-16)
Birthdate____________________________
Second Child’s Full Name:
T-Shirt Size (circle one) Y S(6-8) Y M(10-12) Y L(14-16)
Birthdate____________________________
Third Child’s Full Name:
T-Shirt Size (circle one) Y S(6-8) Y M(10-12) Y L(14-16)
Birthdate____________________________
AS
AM
A L A XL
Age as of Dec 1st______________
AS
AM
A L A XL
Age as of Dec 1st______________
AS
AM
A L A XL
Age as of Dec 1st______________
Family Information

Father/Guardian’s Name____________
Email Address_______________________________________
Phone Number_______________________ Cell Phone___________________________ Volunteer Form: Yes/No

Mother/Guardian’s Name_______________
Email Address____________________________
Phone Number_______________________ Cell Phone___________________________ Volunteer Form: Yes/No
Please provide the phone number you prefer to be contacted at regarding Swim Team
communications: _____________________________________________________
Emergency Information
Emergency Contact____________________
Phone_______________________________
Any medical conditions that the coaching staff should be aware of:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Team sponsors
The cost is $300 for this 24 week program. The sponsor’s name will be printed on the back of the Swim Team t-shirts.
(
) Yes, I can sponsor a team. Ask for Sponsor Form. Business/Company _____________________________________
Address_______________________________________________________________________________________________
Office use only:
Staff Initials: ____________
Shenango Valley Y Spring Travel Team
Date:_________ Receipt #_____________ Membership Type______________ Exp Date: ____________
Waiver Liability & Indemnity Agreement
Shenango Valley YMCA Membership/Program/Special Event Release and Waiver of Liability
My child(ren) has/have doctor’s permission to participate in YMCA activities/membership. I/we fully understand the
potential risks involved in participation with this program/membership. In the event that a medical emergency should
occur I/we hereby give permission on behalf of our child(ren) to receive emergency medical treatment.
I/we hereby release, waive, discharge and agree to indemnify and hold harmless the Mercer County Housing Authority,
the Borough of Greenville, the YMCA and their directors, officers, employees, and agents from any loss, liability, damage,
or any cost including any claim or demands therefore on account of any injury to my child(ren) or damage to our property
while my child(ren) is/are upon the YMCA premises, or observing or using any facilities or equipment of the YMCA or
participating in any YMCA program.
I/we hereby consent to having photographs/video images taken of my child(ren) by a YMCA staff member or a
professional approved by the YMCA and the use of such visual images at the discretion of the YMCA. I/we hereby release
the YMCA, its directors, officers, employees and agents from any and all liability, which may arise from taking or the use
of such photographs/images. All negatives, positives, prints, or other visual images shall remain property of the YMCA.
I/we have read and voluntarily sign this release and waiver of liability. I further agree to follow YMCA Safety Policies and
Procedures along with the Program Rules and Regulations and Membership Comfort and Safety Rules and Regulations.
Failure to do so may result in expulsion from the YMCA and its programs. I/we have read and understand the YMCA
Refund Policy on programs/memberships.
GREENVILLE BOROUGH RESIDENTS: I/we understand that my name or that of my child(ren), address, phone number,
membership type and scholarship amount will be reported to the Borough of Greenville for tracking purposes, and hereby grant
permission to the YMCA to report this information.
MERCER COUNTY HOUSING AUTHORITY RESIDENTS: I/we understand that my name or that of my child(ren), address,
phone number, membership type and scholarship amount will be reported to the Mercer County Housing Authority for tracking
purposes, and hereby grant permission to the YMCA to report this information.
PARTICIPANT NAME(s)
AGE(s)
DATE
MOTHER/ LEGAL GUARDIAN
SIGNATURE
DATE
FATHER/ LEGAL GUARDIAN
SIGNATURE
DATE
WITNESS
SIGNATURE
DATE
(CUT)
The reason our membership/program cost is so reasonable is in part due to funding from the United Way and other organizations. Many of these
organizations request the following information in order to continually provide funding. The information below is kept private and confidential.
Survey information will be provided in a group excluding names
Please help us keep our cost low by answering the following:
Ethnicity:
Marital/Children status:
□ White/Caucasian
□ Married with children
□ Black/African
American □ Hispanic//Latino
Household
income:
□ Asian
□ Other
□ Single female, with children
□ Single male,
with children
YMCA Membership
type:
□ $11,999 or under
□ $12,000 to $14,999
□ $25,000 to $49,999 □ $50,000 or above
Employment status:
□ Married, no children
□ Employed
□ Unemployed
□ Retired
□ Single
children
□ $15,000
or no
$24,999
□ other
□ Adult
□ Youth
□ Unknown
□ One Parent Family □ Military □ Financial Aid □ Non – Member
□ Youth/Young Adult
□ Senior □ Family
SHENANGO VALLEY YMCA SEA LIONS
Bank/Credit Card Draft Authorization Form
New
Change of Payment Info
Primary (Billable) Swimmer’s Name(s):__________________________________________________________ (Please Print)
Street Address:________________________________________________________ City:_________________________
BANK DRAFT INFO
CREDIT CARD DRAFT INFO
Bank Name:____________________________________
Card Holder Name:___________________________________
Account Holder Name:___________________________
Card #:_____________________________________________
Account #:_____________________________________
CID# (last 3 digits on back):________
Exp Date:______________
Account Type (Please check): _____ Checking _____ Savings
Credit Card Billing Address:____________________________
ABA Routing #:_________________________________
**A Voided check is required. We are unable to accept
starter checks or deposit slips. A letter from your bank will
also be accepted in lieu of a voided check.
City:_________________ ST:__________ Zip:___________
Guardian/Payor Signature:_________________________________________________________ Date:_______________________
*Must sign to indicate the above information is complete and accurate for Bank or Credit Card Draft
YMCA MONTHLY DRAFT AGREEMENT
1. This payment draft will remain in effect until September 25th, when any remaining balance will be drafted.
2. I understand that in order to cancel this payment draft, I must give the YMCA 15 days notice by completing a pre-printed cancellation form. I
understand that my account may be drafted during this 15-day period. **_______________(Please Initial)
3. I understand that the monthly draft is a minimum of $50, unless I instruct the YMCA to draft a greater amount. I understand that the balance
of any fees owed will be drafted on September 25th.
4. I hereby authorize the YMCA to initiate debit entries to the account listed above to pay for the swim team fees my family owes toward the
upcoming season. I agree that the YMCA’s rights in respect to each such draft shall be the same as if it were a check or draft drawn on you, and
signed personally by me. The authority is to remain in effect until revoked by me in writing, with 15 days notice, or until the final draft, on
September 25th, and I agree that you shall be fully protected in honoring any such check or draft until its conclusion. I further agree that if any
such check or draft be dishonored, whether with or without cause and whether intentionally or inadvertently you shall be under no liability.
5. Should any monthly payment check or draft not be honored by my bank for any reason, I realize that I am still responsible for that payment plus
a returned check/draft fee of up to $30. This is in addition to any processing fee my bank may charge. The original fee and any processing fees
due must be paid in full before the draft plan can continue.
Guardian/Payor Signature:_________________________________________________________ Date:_______________________
*Must sign to accept terms of agreement
HELP US BUILD A STRONGER COMMUNITY (Optional)
Thanks to the generosity of families, individuals and businesses in our community, financial assistance scholarships are available so
that no one is denied participation due to an inability to pay. Help us reach out to ensure service is available to even more local
families and individuals by making a monthly donation to our STRONG KIDS CAMPAIGN.
Yes, I’d love to help by adding a donation to my monthly draft. The amount I would like to donate, in addition to my membership fee, is:
$3 per month
$5 per month
$10 per month
Another amount per month:$___________
*This amount is a voluntary donation, separate from membership fees. If you would like to make any change to your monthly
donation amount, you must notify the YMCA, in writing, with a minimum 15-day notice.
Payor Signature:_________________________________________________________ Date:_______________________
*Must sign to acknowledge intent to donate
YMCA Staff Use Only:
Staff Name:_______________________________________
Date Received:________________________
Total Amount Paid:_______________ Swim Team Fees Paid:_______________
Monthly Donation:_______________ Total Monthly Draft Amount:_______________ Draft Date {
} 25
th
Attached is: _______________ voided check (not starter check or deposit slip) or _______________ Letter from Member’s Bank