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CHABOT SWIM CLUB MEMBERSHIP NUMBER |
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(PLEASE PRINT IN ALL CAPITAL LETTERS)
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ADULT MEMBER #1 (PRIMARY) |
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ADULT MEMBER #2 (SECONDARY) |
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ADDRESS: |
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PHONE NO. |
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PLEASE NOTE ANY ADULT ON MEMBERSHIP CAN CANCEL THE MEMBERSHIP AND RECEIVE THE REFUNDABLE DEPOSIT THEREFORE, IT IS RECOMMENDED THAT BABYSITTERS, NANNIES, ETC. NOT BE LISTED AS A MEMBER A DAYCARE PROVIDER CAN NOW BE ADDED AS A SEASONAL HELPER TAKING CHILDREN TO THE POOL. THIS ALLOWS ONE(1) PERSON CARING FOR A MEMBER'S CHILDREN TO COME TO THE POOL WITHOUT A GUEST PASS WHEN ACCOMPANIED WITH MEMBER'S CHILDREN ONLY. THEY MAY NOT BRING OTHER GUESTS WITH THEM, NOR COME ON THEIR OWN. |
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CHILDREN AND ADDITIONAL ADULT LIVING IN THE HOME LISTED ON MEMBERSHIP DATE OF BIRTH = TWO DIGIT DAY, THREE LETTER MONTH, TWO DIGIT YEAR (EXAMPLE 01/JAN/12) MINIMUM AGE FOR A CHILD TO BRING A GUEST WITHOUT A PARENT IS 14 YRS OLD (UP TO TWO GUESTS PER CHILD VIA GUEST PASS) |
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ADULT'S NAME |
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LIVING IN THE HOME |
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ADULT'S NAME |
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SEASONAL DAYCARE |
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CHILD’S NAME |
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DATE OF BIRTH |
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CHILD’S NAME |
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DATE OF BIRTH |
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CHILD’S NAME |
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DATE OF BIRTH |
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CHILD’S NAME |
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DATE OF BIRTH |
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Dated: _______ Member Signature: _____________________
PLEASE RETURN THIS FORM: VIA EMAIL TO BOARDMEMBERS@CHABOTSWIMCLUB.ORG