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 InformationYour Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Mobile Phone*Email*This will be the username for your online account. Password Enter Password Confirm Password Family Members# of 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)12345678910Spouse/Partner Name First Last Child 1 First Last DOB MM slash DD slash YYYY Child 2 First Last DOB MM slash DD slash YYYY Child 3 First Last DOB MM slash DD slash YYYY Child 4 First Last DOB MM slash DD slash YYYY Child 5 First Last DOB MM slash DD slash YYYY Child 6 First Last DOB MM slash DD slash YYYY Additional Members you would like to request on the account: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 SPONSORS3 CURRENT HASBROUCK HEIGHTS MEMBER REFERENCES. THEY MUST RESIDE IN HH*PLEASE LIST 3 CURRENT HASBROUCK HEIGHTS MEMBERS AS SPONSORSReferral #1* First Last Referral #2* First Last Referral #3* First Last Referral #4 First Last Referral #5 First Last PROOF OF RESIDENCYPLEASE UPLOAD PROOF OF RESIDENCY FOR ANYONE WHO IS ON YOUR MEMBERSHIP THAT 18 OR OLDER Drop files here or Select files Accepted file types: jpeg, png, pdf, Max. file size: 5 MB. Order Token