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Wenonah Swim Club Census
Members are requested to give information about your family for record keeping and insurance purposes in case of an emergency while on swim club property. This information will be kept confidential and only available in case of an emergency. Please only include family members, children and spouses, who will be on your membership.
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* Indicates required question
Email
*
Your email
Family's Last Name
*
Your answer
Bondholder's First Name
*
Your answer
Bondholder's Date of Birth
*
MM
/
DD
/
YYYY
Spouse's First Name
Your answer
Spouse's Date of Birth
MM
/
DD
/
YYYY
Address
*
Your answer
Phone Number
*
Your answer
Spouse Phone Number
Your answer
Child Name and Date of Birth
Your answer
Child Name and Date of Birth
Your answer
Child Name and Date of Birth
Your answer
Child Name and Date of Birth
Your answer
Child Name and Date of Birth
Your answer
Special Member
Babysitter, grandparents, etc. Please add relationship.
Your answer
Emergency Contact Name & Phone Number
*
Your answer
Please list disabilities, allergies, etc.:
Your answer
How did you hear about the swim club? Flyer, mailer, friend, family, Facebook, etc.
*
Your answer
Send me a copy of my responses.
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