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FCSC Membership Application |
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| MEMBERS NAME: |
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ADDRESS: city, state & zip |
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| PHONE NUMBER: |
EMERGENCY |
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| Father: | |
| Mother: (also requires maiden name if grandparents are joining) | |
| Child / Childrens name, age, D.O.B., school, grade, swimmer or non-swimmer: | |
| Grandparent, address and phone #: | |
| comments: | |
Do all individuals listed on this application,
except for grandparents, live at the same address? Will all children listed on this application be under the age of 2 by
MAY 28, 2010? Will any of your children listed on this application be under the age
of 2 before MAY 25, 2009? THE UNDERSIGNED HEREWITH APPLIES FOR MEMBERSHIP AT THE FOX CHASE SWIM CLUB, FOR THE SEASON OF 2010, IF ACCEPTED I/WE AGREE TO ABIDE BY ALL RULES, REGULATIONS AND BY-LAWS OF THE CLUB AS THEY NOW EXIST OR AS THEY HEREAFTER BE AMENDED. I/WE DO HEREBY RELEASE AND SAVE HARMLESS FOX CHASE SWIM CLUB, INC. AND ITS OFFICERS AND EMPLOYEES FROM ANY AND ALL LIABILITY AND HEREBY WAIVE ANY CLAIMS FOR INJURIES, LOSS OR DAMAGE TO MYSELF/OURSELVES, AND TO MY/OUR CHILDREN, AND OUR GUESTS THAT MAY ARISE IN CONNECTION WITH OUR USE OF FOX CHASE SWIM CLUB. I/WE ALSO AGREE TO ASSUME FULL RESPONSIBILITY FOR ALL GUESTS BROUGHT TO FOX CHASE SWIM CLUB BY MYSELF OR MY FAMILY. THE RIGHT TO REJECT THIS APPLICATION IS RESERVED. I HAVE READ AND UNDERSTAND ALL RULES, REGULATIONS AND BY-LAWS OF FOX CHASE SWIM CLUB. SIGNATURE _________________________________________________________________________________________________ |
Return this
form along with photos, FOX CHASE SWIM CLUB Minimum deposit is $100 |
FOR CLUB USE ONLY Total Fee: ______________________ Deposit: _____________________ Date: ________________________ Balance: _______________________ Final Payment: __________________ Date: _________________________ TOTAL: ______________________ |
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