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HEART OF THE HILLS SWIM
CLUB, INC.
ANNUAL REGISTRATION AND EMERGENCY INFORMATION
This form should be submitted to make corrections to the registration/emergency contact information we have on file. You need only complete the information that needs to be corrected as well as your membership number and last name.
Fields marked with an * are required.
Member
Number:*
Last Name:*
Phone Number: ()
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This is the phone number we will use to contact you in non-emergency situations.
Address: City: State: Zip:
E-mail Address:
Email will be used for various summer communications - please provide at least one valid email address.
EMERGENCY CONTACT INFORMATION:
In case of emergency, we will contact you at the numbers listed below in the order that they are listed. (If you want us to call the Phone # listed above, please list it again.)
1. Name:
Phone Number: ()
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2. Name:
Phone Number: ()
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FAMILY ADMISSION INFORMATION:
Please put the names (first and last) and birthdates (mm/dd/yy) of all family members who will be using the club this summer. Photos will be taken at the club and are required for admission. Children age 21 and older and other family members will be asked to show proof of residence. (Use the appropriate form for babysitters and nonresident grandparents.)
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