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HEART OF THE HILLS SWIM
CLUB, INC.
ANNUAL REGISTRATION AND EMERGENCY INFORMATION
New members please complete all information - returning members need only complete information that has changed from last year.
With the rising cost of postage we will be using e-mail for communcation as much as possible. Please provide a valid e-mail address.
Fields marked with an * are required.
Member
Number:*
Last Name:*
Address: City: State: Zip:
Phone Number:
E-mail Address:
EMERGENCY CONTACT INFORMATION:
In case of emergency, we will try to reach you at your home phone number. However, please include at least one alternate number - a neighbor or relative's phone number, work phone number, or cell phone number.
FAMILY ADMISSION INFORMATION:
Please put the names (first and last) and birthdates (mm/dd/yy) of all family members who will be using the club this summer. Photos will be taken at the club and are required for admission. Children age 21 and older will be asked to show proof of residence.
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