2019 Registration - Swim Club If you are human, leave this field blank. Contact Information First Name * Last Name * Address * City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code * Phone Number * Email Address * Select Membership Type * Full Evening Weekend Weekday Baby Pool Full Membership • 10% Senior (65+) discount on full membership only with proof of age (submit with application) • A family includes all unmarried children under the age of 21 living at home. No charge for children under 18 months of age as of Memorial Day. • Baby pool opens at noon on weekends and holidays. Do you have more than 4 members that you would like to enroll? * Yes No Family of MORE than 4? No problem! Enter the amount OVER 5 * Each additional member is only $110 Full Membership Pricing * Single: $335 Family (2 or less): $590 Family (3 or less): $700 Family (4 or less/more than 5): $800 Additional Family Member Dollar Amount Evening/Weekend Membership Permits Club usage from 4:15 pm till closing on weekdays and all day on weekends and holidays. Does not include weekdays before 4:15pm. Membership times strictly enforced. If you wish to use the pool before 4:15pm on weekdays, you must come as the guest of a member with access to the Club during that time. A family includes all unmarried children under the age of 21 living at home. No charge for children under 18 months of age as of Memorial Day. Evening/Weekend Membership Pricing * Single: $250 Family (2 or less): $460 Family (3 or less): $540 Family (4 or less/more than 5): $640 Do you have more than 4 members that you would like to enroll? * Yes No Family of MORE than 4? No problem! Enter the amount OVER 5 * Each additional member is only $80 Additional Family Member Dollar Amount Weekday Afternoon Membership Permits Club usage from noon to 4pm, Monday through Friday. No weekends or holidays. Membership times strictly enforced. Select Membership Level * One Member $130 Two Members $250 Three Members $375 Four Members $500 Weekday Afternoon Membership Total * Weekday Baby Pool Membership * NO WEEKENDS OR HOLIDAYS NO DIAPERED BABIES OR TODDLERS ARE PERMITTED IN THE MAIN POOL Permits club usage from 10am to 11:45am, Monday through Friday. No weekends or holidays: (Memorial Day, 4th of July, and Labor Day) Membership times strictly enforced. Weekday Baby Pool Membership Pricing * Adult and One Child Five or under: $105 Adult and Two Children: $160 Do you have more family members you would like to enroll?? * Yes No Each additional member is $55 More family members? Please enter the amount * Each additional member is only $60 Additional Family Member Dollar Amount Single Member Please enter the name of the person you need an ID card printed. First Name * Last Name * Gender * Male Female Is the member under 18? * Yes No Date of Birth * Parent Name (Mother) * Parent Name (Father) Family Membership of 2 Please enter the name of the person you need an ID card printed. Family Member 1: First Name * Family Member 1: Last Name * Family Member 1: Gender * Male Female Family Member 1: Under 18? * Yes No Family Member 1: Date of Birth * Family Member 1: Parent Name (Mother) * Family Member 1: Parent Name (Father) * Family Member 2: First Name * Family Member 2: Last Name * Family Member 2: Gender * Male Female Is the Family Member 2 under 18? * Yes No Family Member 2: Date of Birth * Family Member Parent Name (Father) * Family Member Parent Name (Mother) * Family Membership of 3 Please enter the name of the person you need an ID card printed. Family Member 1: First Name * Family Member 1: Last Name * Family Member 1: Gender * Male Female Family Member 1: Under 18? * Yes No Family Member 1: Date of Birth * Family Member 1: Parent Name (Mother) * Family Member 1: Parent Name (Father) * Family Member 2: First Name * Family Member 2: Last Name * Family Member 2: Gender * Male Female Is the Family Member 2 under 18? * Yes No Family Member 2: Date of Birth * Family Member 2 Parent Name (Father) * Family Member 2 Parent Name (Mother) * Family Member 3: First Name * Family Member 3: Last Name * Family Member 3: Gender * Male Female Is the Family Member 3 under 18? * Yes No Family Member 3: Date of Birth * Family Member 3 Parent Name (Mother) * Family Member 3 Parent Name (Father) * Family Membership of 4 Please enter the name of the person you need an ID card printed. Family Member 1: First Name * Family Member 1: Last Name * Family Member 1: Gender * Male Female Family Member 1: Under 18? * Yes No Family Member 1: Date of Birth * Family Member 1: Parent Name (Mother) * Family Member 1: Parent Name (Father) * Family Member 2: First Name * Family Member 2: Last Name * Family Member 2: Gender * Male Female Is the Family Member 2 under 18? * Yes No Family Member 2: Date of Birth * Family Member 2 Parent Name (Father) * Family Member 2 Parent Name (Mother) * Family Member 3: First Name * Family Member 3: Last Name * Family Member 3: Gender * Male Female Is the Family Member 3 under 18? * Yes No Family Member 3: Date of Birth * Family Member 3 Parent Name (Mother) * Family Member 3 Parent Name (Father) * Family Member 4: First Name * Family Member 4: Last Name * Family Member 4: Gender * Male Female Is the Family Member 4 under 18? * Yes No Family Member 4: Date of Birth * Family Member 4 Parent Name (Mother) * Family Member 4 Parent Name (Father) * Additional Family Members Please list additional members that are OVER 18 * Please list additional members that are UNDER 18 including Date of Birth * Total Membership Cost (Before Discount) $ Click for Applicable Discounts Flourtown Summer Day Camp Enrollment My child is attending 4 weeks or more of the Flourtown Summer Day Camp: 50% Discount on Any Membership Name of Child Attending Day Camp Senior Discount 10% Senior (65+) discount on full membership only with proof of age Proof of Age for Senior Discount Uploading Files. Please Wait. Drop a file here or click to upload Choose File Maximum upload size: 67.11MB Refund Notice Refund Policy Acceptance * I am aware that a refund (less a $100 processing fee) will be made only if membership is cancelled with a written notice received by Memorial Day. Babysitter Notice Babysitter Policy Acceptance * I am aware that BABYSITTERS AND AU PAIRS MAY SHARE A MEMBERSHIP WITH ONE PARENT. CONTACT FOR DETAILS. If the sharing parent and babysitter come on the same day, one must pay the required guest fee. Total Membership Cost (After Discounts) $ Credit Card * Credit Card Credit Card Credit Card Month 1 2 3 4 5 6 7 8 9 10 11 12 Credit Card Year 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 Credit Card Signature * Draw It Type It Clear I agree to abide to Current Rules and Regulations that can be found at www.flourtownswimclub.net and posted at the Swim Club
