2017 Nahunta Swim Club Information Sheet

2017 Nahunta Swim Club Information Sheet

Current Share and Season Pass holders complete this form and submit with your yearly fee, by May 20, 2017. New members complete this form and mail along with your payment to Nahunta Swim Club, C/O Renee Sauls, 243 Pinkney Ch. Rd., Fremont, NC 27830. You will be contacted concerning approval once your references have been contacted. We look forward to seeing you at the pool this summer.

Type of Membership (Circle One): Share Holder Season Pass Holder

Member Names: Please list names of all household members

Father: ______

Mother: ______

Child 1: ______Age: ______

Child 2: ______Age: ______

Child 3: ______Age: ______

Child 4: ______Age: ______

Child 5: ______Age: ______

Children must be 12 years old in order to be dropped off at the pool without a parent, sibling, or babysitter.

If you will use a babysitter for your child(ren) at the pool, please list his/her name(s). (Babysitter must be at least 16 years of age. Only one babysitter per visit, per day.)

Babysitter Name(s): ______

Contact Information:

Home address: ______

Email address: ______

Home phone #: ______

Father’s cell phone #: ______

Mother’s cell phone #: ______

May we contact you via text and/or email? Text: Yes NoEmail: Yes No

Emergency Contact:

In case of an emergency please list someone we may contact.

Name: ______Phone #: ______

Health Information:

Please list any health condition or allergy that would be important for our lifeguards

to know about your family members.

Name: ______Allergy: ______

Explanation:

For New Members Only (Required):

Please list two references.

Name: ______Phone #: ______

Name:______Phone #: ______

Note: Household members must reside at the address provided on this form. Exceptions to this rule must be brought before the Board of Directors of the Nahunta Swim Club and will be voted on by a case-by-case basis.