Pool Club Application – Wilson Boatyard Marina

MEMBERSHIP & FAMILY INFORMATION

MemberID

Returning Member?(Required) No
Yes

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Returning Member?(Required)

Yes

NEW UNLIMITED MEMBERSHIP OPTIONS ADDED. USE THE DROPDOWN TO VIEW ALL AVAILABLE OPTIONS.

Type of Membership(Required)

**Family Membership consists of up to 2 Adults/Guardians and up to 2 kids 22 years of age and under. Additional children can be included using the options below.

Adult #1(Required)

Adult #2

Child #1

Child #1 Age

Child #2

Child #2 Age

Add Children - Family Membership

**2 children are included in the base price. Use these options to add more children to your membership.

Add Children - Family Membership Unlimited

**2 children are included in the base price. Use these options to add more children to your membership.

Child #3(Required)

Child #3 Age(Required)

Child #4(Required)

Child #4 Age(Required)

Child #5(Required)

Child #5 Age(Required)

Child #6(Required)

Child #6 Age(Required)

Child #7(Required)

Child #7 Age(Required)

Child #8(Required)

Child #8 Age(Required)

Subtotal

CONTACT INFORMATION

Email(Required)

Address(Required)

Primary Phone(Required)

Secondary Phone

Work Phone

Emergency Contact

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Alt Phone

Relationship(Required)

HEALTH

Please list any health or physical conditions which may raise the risk of death or injury to self or others so that the WHPC can take any precautionary steps that are appropriate to assist the member.

AGREEMENT

Signature #1(Required)

Use your finger or mouse to sign this document.

Signature #2(Required)

Use your finger or mouse to sign this document.

Payment Information

Mid-Summer Discount

$0.00

Total Due

Credit Card Details(Required)

Comments

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