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Laurelhurst Recreation, Inc. ~
Cabana Club
1063 Colony Hills Lane ~
Cupertino, CA 95014 ~ (408) 725-9389 ~ FAX (408) 252-8938
2010 MEMBERSHIP APPLICATION
MID-SEASON PRORATED MEMBERSHIP
FOR A PRINTABLE
VERSION (ADOBE ACROBAT) OF THIS FORM, CLICK
HERE.
DATE:_____________________
FAMILY
NAME:_________________________________________ PHONE:
_____________________
ADDRESS:_____________________________________________________
OWN____ RENT____
CITY:______________________________ ZIP:_______________ YEARS AT THIS ADDRESS:_______
E-MAIL: _______________________________________________
FAMILY MEMBERS:
(PLEASE INDICATE WITH A "Y or N" THOSE CHILDREN WHO CAN and CANNOT SWIM -
LESSONS MAY BE
AVAILABLE).
ADULTS (first names) : _______________________________
__________________________________
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CHILDREN'S
NAMES |
SEX |
BIRTH DATE |
GRADE |
SCHOOL |
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OTHERS RESIDING WITH FAMILY:
________________________________________________________
PLEASE PROVIDE THE FOLLOWING ADDITIONAL
INFORMATION:
OCCUPATION(S):
HUSBAND's:________________________________EMPLOYER:__________________________________________
WORK PHONE:_____________________________
WIFE's:____________________________________
EMPLOYER:__________________________________________
WORK PHONE:_____________________________
SPECIAL NEEDS OR CONDITIONS OF ANY FAMILY
MEMBERS:___________________________________________
OTHER EMERGENCY PHONE CONTACT (IMPORTANT!) Name:_______________Phone:_______________________
WE WILL PROBABLY
__WALK,
__BICYCLE, __DRIVE TO THE POOL.
VEHICLE INFO: MAKE:____________MODEL:___________ COLOR: _________VEH. LIC.
NO.:_________________
Please return this completed
form (all lines must be filled in, or your application is
invalid) along with your PRORATED membership dues ($375) to Laurelhurst Recreation Inc.
(LRI), at the address above.
Membership is limited. Your membership is subject to board
approval.
I AGREE TO ABIDE BY ALL LRI RULES, POLICIES, and PROCEDURES (POSTED AT POOL)
X____________________________________________
_______________________________________
(SIGNATURE)
RECOMMENDED BY (optional):
HOME MEMBERSHIP
RULES CONTACT NEWS SPLASH
JOIN
PARTY RES
LIFEGUARD APPLICATION
LIFEGUARD SCHEDULE
© 2010, Laurelhurst
Recreation, Inc.
Hours and fees subject to change.
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