Laurelhurst Recreation, Inc. ~ Cabana Club
1063 Colony Hills Lane ~ Cupertino, CA 95014 ~ (408) 725-9389 ~ FAX (408) 252-8938
 2012 MEMBERSHIP APPLICATION 
 
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) : _______________________________    __________________________________

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) SEND NO MONEY UNTIL YOUR APPLICATION IS ACCEPTED. Membership is limited. Your membership is subject to board approval.  Family membership
dues for 2011 are $700 plus a one time $50 initiation fee.

I AGREE TO ABIDE BY ALL LRI RULES, POLICIES, and PROCEDURES (POSTED AT POOL)

X____________________________________________                      _______________________________________
                                  (SIGNATURE)                                                                              RECOMMENDED BY (optional):

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© 2012, Laurelhurst Recreation, Inc.
Hours and fees subject to change.