Swimmer: _______________________ ______________________ _____________________
Last Name First Name Middle Name
Gender (M/F): ___________ Birthdate (mm/dd/yy): __________________ Current Age:___________
USMS Swimmer: YES / NO If YES: Please provide a copy of your USMS membership card.
Address: _______________________________________ ________________________ _________________
Street City Zip Code
Home Phone #:____________________ Cell:____________________ Work:____________________________
Primary Email Address:____________________________ Secondary Email: _____________________________
Emergency Contact Name:__________________________________________ Relationship:__________________
Emergency Contact Phone #:___________________________ Alternate Phone #:___________________________
Medical Disclosure & Release:
Please list any health problems, medications or drug allergies of which FINS Masters should be aware:
I, ____________________________________, recognize the possibility of physical injury associated with the
activities included in FINS Masters programs. I hereby release, discharge and/or otherwise agree to indemnify and
hold harmless FINS Masters, its Owner, Coaches, Advisory Board, volunteers, agents, and employees against any
liability resulting from any injury that may occur while participating in any of FINS Masters programs. I also agree to
indemnify FINS Masters for any damages incurred arising from any claims, demand, action or cause of action by
myself. It is my responsibility to inform the coach in charge of any major medical concerns of which he/she should be
Signature: ____________________________________________ Date: _______________________________
I approve and consent to the use of my name, photo and/or video in FINS Masters advertisements, newsletters,
publications, website, press releases or other similar uses:
FINS Masters Payment Options:
Monthly Fees: $75
Punch Cards: $85 for 10 swims
College Rate (age 18-24 or full-time student): $50/month or $60 punch card for 10 swims
* Please make all checks payable to: “Team FINS” with the word “Masters” written in the memo line.
REQUIRED: 2011 Annual US Masters Swimming Registration - $34 for the remainder of 2011:
US Masters Swimming membership is required for all FINS Masters swimmers for insurance purposes.
Registration may be completed online at: www.gulfmastersswimming.org
Registrations submitted after 10/31/2011 can be registered as 2012 members.
Swimmers must register as “Unaffiliated” for 2011 as we are in the process of creating an official FINS
Masters team for 2012.
* A copy of your USMS membership card must be given to a FINS Masters Representative at the time
FINS Masters Practices
Monday – Thursday: 5:30 – 6:30 a.m. @ Giammalva
Saturday: 7:00 – 8:30 a.m. @ FINS
Giammalva Racquet Club: FINS Spring/Klein Location:
16400 Sir William Dr. 7827 Spring Cypress Rd.
Spring, TX 77379 Spring, TX 77379
(Inside Wimbledon subdivision) 281-379-3467
Recommended Equipment: FINS Masters Contact & Coach:
Fins Becki Lyn Skidmore
Mesh Bag (to hold equipment)
2011-2012 Financial Policies
Please read and review each policy, initial each one and then sign at the bottom:
_______ FINS Masters is a year round swim program. Members are liable for each entire monthly payment
including any months where practice is not held due to a holiday. Monthly dues are not pro-rated when
members leave the team.
_______ Prompt payment of monthly dues is required. Payment will be due by the 10th of each month with a late
fee of $15 being assessed after the 15th of each month.
________ Monthly payments may be made by check or cash and placed in the FINS Masters Envelope at the front
desk of FINS or mailed to: FINS Masters, Attn: Becki Lyn Skidmore, 7827 Spring Cypress Rd., Spring,
TX 77379. All checks must be made payable to Team FINS. The word “Masters” must be written on the
memo line of the check.
________ If any payments due to FINS Masters are more than 30 days past due, swimmers will not
be allowed to attend practices until their account balance is paid in full.
I have read and understand each of the above financial policies as indicated by my initial by each
policy and by my signature below.
Signature _______________________________ Date: ____________________