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Edgewood Eels 2018 Swim Team Registration Form

CHILDREN MUST BE ABLE TO SWIM TWO LENGTHS OF THE POOL TO PARTICIPATE ON SWIM TEAM

Members Name*
Street Address*
City*
State*
Zip*
Email Address*
Phone*
Swim Team Fees First Child - $ 125.00
Each Additional Child in Family - $25.00
Please enroll my child(ren)
First Child* $125.00
Date of birth*
Age*
Second Child $25.00
Date of birth
Age
Third Child $25.00
Date of birth
Age
Name on card*
Credit Card Number*
VIN number on from the back of card*
Exp. Date
valid thru 10.31.2018*
Card type*

Credit Card Billing Address (only if different than listed above)
Street Address
City
State
Zip
As the credit card holder, I hereby authorize The Edgewood Club, to charge my credit card for the selected membership category and future fees verbally approved by me. *
I have read the WAIVER RELEASE OF RESPONSIBILITY (CLICK HERE) AND I HAVE FULL KNOWLEDGE OF ITS CONTENTS AND SIGNIFICANCE*
 
 
WELCOME HISTORY AMENITIES MEMBERSHIP WEDDINGS & EVENTS CONTACT US & GUEST INFORMATION MEMBER LOGIN   The Edgewood Club
One Pennwood Avenue
Pittsburgh, PA 15218-1627
412.731.3443
info@edgewoodclub.com