<p> Loyola Blakefield Aquatics Inc. Registration Form This must be filled in by all this year. If all information is the same just write in Name and write SAME Swimmers Name:</p><p>Last:______First:______Middle:______</p><p>Age:______Date of Birth:______</p><p>Check One: Male:______Female:______</p><p>Phone: ______</p><p>E-Mail (Parent):______</p><p>Parent/Parents Name:______,______</p><p>Address:______</p><p>______</p><p>T-Shirt Size for your child:______T-Shirt and Cap included. Shirt sizes Adult small, medium, large, xlarge………………also in youth medium and large</p><p>Loyola Blakefield Aquatics, Inc. is a non-profit corporation, and it is not a part of or agent for Loyola Blakefield School. By signing this agreement you agree to pay dues for the entire year. If for some reason you child does not swim for the entire year, dues will not be refunded.</p><p>______Swimmers Signature Parent or Guardian of Swimmer (if swimmer under the age of 18)</p><p>*Make copies of this form as needed *This form and $200.00 Deposit per swimmer due by June 19th LBA Dues Statement</p><p>The following is a list of Fees for the 2015-2016 Season. The Fees were decided by the Presi- dent, Treasurer, and Head Coach of LBA Inc. ALL DUES INCLUDE THE $86.00 USA REGISTRATION FEE and a LBA Swim Cap and LBA T-Shirt</p><p>Loyola Students: $1125.00 total $200.00 deposit by June 19th. $555.00 payable by the end of September $370.00 payable by the end of February Non-Loyola Students: Senior Group $1525.00 total $200.00 deposit by June 19th. $795.00 payable by end of September $530.00 payable by end of February</p><p>Age Group I $1125.00 total $200.00 deposit by June 19th. $555.00 payable by end of September $370.00 payable by the end of February</p><p>Age Group II $1325.00 total $200.00 deposit by June 19th. $675.00 payable by the end of September $450.00 payable by the end of February</p><p>Smurf Group $860.00 total $200.00 deposit by June 19th. $435.00 payable by end of September $225.00 payable by end of February</p><p>Family Discount……….$50.00 off 2nd child, $150 ,00 off of 3rd and 4th child No discount off of Loyola Student Fees. This means if you have two family members swimming and one is a Loyola student there is no discount. If you have three family members swimming and one is a Loyola Student then you deduct $50.00</p><p>Mail Payment To: Keith Schertle 144 Westbury Rd Lutherville Md. 21093 $200.00 Deposit per swimmer due by June 19th.</p>