Membership Registration Form

"*" indicates required fields

Please fill out this form to create an account with Hasbrouck Heights Swim Club. All applications will be reviewed for approval prior to acceptance.

Account Information

Your Name*
Address*
This will be the username for your online account.
Password

Family Members

Please enter the total number of people who will be using this membership including yourself. E.g.,: For yourself plus a spouse and one child enter 3. DO NOT INCLUDE OR LIST NANNY PASS (will be done when invoicing)
Spouse/Partner Name
Child 1
MM slash DD slash YYYY
Child 2
MM slash DD slash YYYY
Child 3
MM slash DD slash YYYY
Child 4
MM slash DD slash YYYY
Child 5
MM slash DD slash YYYY
Child 6
MM slash DD slash YYYY
ALL MEMBERS MUST BE FULL-TIME RESIDENTS AT YOUR LISTED ADDRESS. Please enter the member who you would like to request be added to the account, with name, DOB (mm/dd/yyyy), and relationship ie.:Johnny Tentpeg 04/15/2011

HASBROUCK HEIGHTS SPONSORS

PLEASE LIST 3 CURRENT HASBROUCK HEIGHTS MEMBERS AS SPONSORS
Referral #1*
Referral #2*
Referral #3*
Referral #4
Referral #5
PLEASE UPLOAD PROOF OF RESIDENCY FOR ANYONE WHO IS ON YOUR MEMBERSHIP THAT 18 OR OLDER
Drop files here or
Accepted file types: jpeg, png, pdf, Max. file size: 5 MB.