OMNI REGISTRATION SHEET

Swimmers

First Name:                                                       Last:                                                                 MI       

 

Address:                                                           City:                                                     Zip:                  

 

Home Phone Number:                                                   Date of Birth:                            Age:                

 

Swimmer's Email Address:                                                                                                                    

 

Father's Name:                                                              Email:                                                              

 

Employer:                                                                     Work Phone Number:                                       

 

Mother's Name:                                                                        Email:                                                              

 

Employer:                                                                     Work Phone Number:                                       

 

Swimming Experience (i.e. swim club, summer club, lessons):                                                                 

 

How did you hear about OMNI:                                                                                                            

 

Training Groups

O Senior

O Junior

O Age Group

O Mini-OMNI

Full Year:

$1,200

$900

$600

$300

Winter Season only:

$800

$600

$400

$200

Summer Season only:

$650

$450

$250

$150

A minimum of 1/4 training fee and USS registration fee is due at time of registration.

 

Payment Schedule

 

 

Payment #1

Payment #2

Payment #3

Payment #4

Training Fee:

 

Amount Due:

 

 

 

 

Discount %:

 

Amount Paid:

 

 

 

 

Sub Total:

 

Balance:

 

 

 

 

USS Registration:

$55.00

 

 

 

 

 

Total:

 

Check #:

 

 

 

 

Discounts available for families with multiple swimmers. 

Child in the most advanced group pays in full, 2nd 20% off, 3rd 35% off, 4th 50% off and 5th FREE. 

Full Year plan:

#1 September 25th,

#2 January 8th,

#3 April 8tb,

Final July 9th

Winter plan:

#1 September 25th,

#2 November 6th,

#3 January 8th,

Final February 20th

Summer plan:

#1 April 8th,

#2 May 8th,

#3 June 5th,

Final July 9th

“I, the undersigned, parent or guardian of the above named minor, do hereby register said swim program.  I do release, acquit and discharge the OMNI Swim Club, Yale University and all of its members individually from any and all claims, demands, actions and cause of action, which I or my representative may have by reason of any injury or illness which may occur as a result of said minor’s participation in said program. I have read the foregoing completely and carefully and understand said responsibility.”

 

 

Parent Signature:                                                                                               Date: