Trident Swim and Tennis Club
2017 Membership Application
Referred by (New members only):
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First Name *
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Last Name *
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Spouse
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Type of Membership *
Street Address *
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City *
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State *
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Zip Code *
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Phone Number *
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Alternate Phone Number
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Email Address *
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Alternate Email Address
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Child 1
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Date of Birth
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Child 2
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Date of Birth
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Child 3
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Date of Birth
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Child 4
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Date of Birth
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Child 5
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Date of Birth
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Child 6
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Date of Birth
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Child 7
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Date of Birth
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Known Medical Conditions (please note N/A if none) *
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Emergency Contact Name *
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Emergency Contact Phone Number *
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Alternate Emergency Contact Name
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Alternate Emergency Contact Phone Number
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Guest Passes (10 for $40)
Babysitter (Fee $80)
Babysitter Name
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Are you interested in Swim Team? (Payment will be due at swim team sign up night. Details to follow on the date/time.)
Names of children for swim team
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Are you interested in Pre-Swim Team (children must be at least 5 years old)? Payment will be due on the pre-swim team screening day, to be scheduled early summer.
Names of children for pre-swim team
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My family understands and agrees to the terms of Trident Swim and Tennis Club Rules and Guest Policies. *
Required
If a medical emergency occurs and none of the emergency contact people can be contacted, the staff of Trident Swim and Tennis Club has permission to seek emergency medical treatment for my family member(s) at the nearest hospital. *
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I certify that the above Membership information provided is true and accurate. *
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Comments/Questions
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Yes, I would be interested in contributing additional funds towards a capital improvements, and I will add this amount into my dues check:
Yes, I am interested in helping with fundraising and/or social events. Please contact me at the following email address:
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Checks should be made payable to Trident Swim and Tennis Club. Please mail checks to: Trident Club Inc., c/o Membership, PO Box 3127, Wescosville, PA 18106. Dues received between April 2 and May 26, 2017 are $541. After May 26, 2017, dues are $566. If you are paying in installments, the three payments are due 3/1, 4/1, 5/1. *
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