Brookside New Member Application
Last Name *
Your answer
Name of Primary Bond Holder *
Your answer
Date of Birth for Primary Bond Holder *
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DD
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YYYY
Is the primary bond holder a senior citizen? *
Name of 2nd Adult
Your answer
Date of Birth of 2nd Adult
MM
/
DD
/
YYYY
Name of 3rd Adult
Your answer
Date of Birth for 3rd Adult
MM
/
DD
/
YYYY
Name of 4th Adult
Your answer
Date of Birth for 4th Adult
MM
/
DD
/
YYYY
Name of Babysitter
Your answer
Date of Birth for Babysitter
MM
/
DD
/
YYYY
Name of 1st Child
Your answer
Date of Birth for 1st Child
MM
/
DD
/
YYYY
Name of 2nd Child
Your answer
Date of Birth for 2nd Child
MM
/
DD
/
YYYY
Name of 3rd Child
Your answer
Date of Birth for 3rd Child
MM
/
DD
/
YYYY
Name of 4th Child
Your answer
Date of Birth for 4th Child
MM
/
DD
/
YYYY
Name of 5th Child
Your answer
Date of Birth for 5th Child
MM
/
DD
/
YYYY
What is your full address? *
Your answer
Please list your telephone numbers *
Your answer
Please list your e-mail addresses *
Your answer
If a member referred you, what was their name?
Your answer
Do you have any additional comments or questions?
Your answer
How will you be paying for your bond? *
How will you be paying for your repairs assessment? *
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