Laurelhurst Recreation, Inc. ~ Cabana Club
1063 Colony Hills Lane ~ Cupertino, CA 95014 ~ (408) 725-9389 ~ FAX (408) 252-8938
2008 MEMBERSHIP APPLICATION 
OUR 2008 MEMBERSHIP ROSTER IS FULL.  IF YOU WOULD LIKE TO SUBMIT
 AN APPLICATION FOR 2009, FEEL FREE TO  FILL OUT AND SEND IN THIS FORM.
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.:_________________

DO NOT SEND ANY MONEY AT THIS TIME.  YOU WILL BE CONTACTED BY A BOARD MEMBER.
Please return this completed form (all lines must be filled in, or your application is invalid) 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):
 

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© 2008, Laurelhurst Recreation, Inc.
Hours and fees subject to change.