SUMMER PROGRAM 2016 ­ MEMBERSHIP CHECKLIST Member’s Name:_________________________________________ Age:_____________ ___________ Completed Membership Application (all lines on the application must be filled

out; incomplete applications will not be considered and will result in your child being placed on a waiting list.

___________ Signed Membership Orientation Handbook ___________ Immunization Records ___________ Physical Form ___________ Birth Certificate ___________ 2 Emergency Contacts other than Parents ___________ $10 Registration Fee

YES Program participants are required to pay registration fee.

PAYMENT OPTIONS PAY PER DAY PAYMENT IN FULL (BY: APRIL 30TH)

$5.00 PER DAY ($7 on Pool Days)

$135.00 (10% Discount Included)

*Teens will pay pool days separately. They will need to bring $2.00 to swim on these days.* Unit Director’s Initials:____________ Date:_____/_____/______ Unit/Site: WTZ Grade:________________