2023 Forest Park Registration Please enable JavaScript in your browser to complete this form. - Step 1 of 4Membership Statement Section 2.1. A membership may be owned jointly by husband and wife, or singularly by husband or wife or unmarried head ofhousehold. All of the rights, duties, obligations and benefits of membership shall insure to the immediate family residing togetherwith owner(s) in a single household.Section 2.2. Member(s) shall designate family members (Limited to (8) eight) each year upon payment of membership dues.Designated family members shall enjoy all rights and privileges of membership.Designated family members must be related to Member(s) (as a child, stepchild, adopted or foster child, parent.)Section 2.2.1 Member(s) may, as one of the eight designated Family members, designate a childcare provider who shall enjoy all rightsand privileges of membership during the course and scope of performing duties as a childcare provider for a member. As stated in the ByLaws, ARTICLE VII: Section 4 - No member shall be deemed in good standing, unless and until the records kept by the Treasurer reflect such member has paid in full all dues, work party fines, penalties and assessments levied in accordance herewith. Members whose dues are two (2) months in arrears shall be notified in writing by the Board of Directors. Unless approved by the Board, Failure to pay dues within thirty (30) days of written notification shall result in the membership reverting to the corporation without remuneration. Family Name *Email *Billing Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCell Phone *Home PhoneReferred by:FirstLastWhat is your contact preference? *EmailTextBothNextMembership InformationName - Primary Member *FirstLastLayoutPrimary Member Birthday *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age of Primary Member *18 - 2526 - 3435 - 4445-5455 - 6061+Which membership are you interested in? *Family MembershipSenior MembershipName - Secondary MemberFirstLastSecondary Member BirthdayMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorHow many additional family members will be on your account? *012345678Additional Family Member 1Additional Family Member 1 - NameFirstLastLayoutAdditional Family Member 1 - BirthdayMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Primary MemberAdditional Family Member 2Additional Family Member 2 - NameFirstLastLayoutAdditional Family Member 2 - BirthdayMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Primary MemberAdditional Family Member 3Additional Family Member 3 - NameFirstLastLayoutAdditional Family Member 3 - BirthdayMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Primary MemberAdditional Family Member 4Additional Family Member 4 - NameFirstLastLayoutAdditional Family Member 4 - BirthdayMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Primary MemberAdditional Family Member 5Additional Family Member 5 - NameFirstLastLayoutAdditional Family Member 5 - BirthdayMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Primary MemberAdditional Family Member 6Additional Family Member 6 - NameFirstLastLayoutAdditional Family Member 6 - BirthdayMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Primary MemberAdditional Family Member 7Additional Family Member 7 - NameFirstLastLayoutAdditional Family Member 7 - BirthdayMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Primary MemberAdditional Family Member 8Additional Family Member 8 - NameFirstLastLayoutAdditional Family Member 8 - BirthdayMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Primary MemberPreviousNextInsurance & Emergency ContactsPrimary Insurance CarrierInsured EmployeeGroup NumberEmployee NumberSecondary Insurance CarrierInsured EmployeeGroup NumberEmployee NumberEmergency Contact 1 *FirstLastHome PhoneCell Phone *Emergency Contact 2FirstLastHome PhoneCell PhoneNextMembership Terms & Conditions I agree to pay the yearly membership dues. I understand that if I do not maintain my membership, per the by-laws, my membership will revert to the Forest Park Swimming Association. I understand that the pool and payment of dues is governed by the Forest Park Swimming Association by-laws. I acknowledge that I have been given a copy of these by-laws. I agree that my family, my guests and I will abide by the safety rules and code of conduct established by "The Association." I understand that each membership is responsible of 12 volunteer hours as a part of my membership: ** I will complete 12 volunteer hours, or pay a $25.00 per volunteer hour fine for commitments not completed. Volunteering is a scheduled gatekeeping shift or yard maintenance shift, any combination (12 hours) total. Volunteer hours are scheduled throughout the year. Fines are due and payable by September 2022, unless alternate arrangements are made with the Board of Directors.Checkboxes *I agree to the membership termsSelecting this box serves as a signature that you are agreeing to the the membership terms and conditions above. Agreement Date *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature *Clear SignaturePayment InformationWhich payment method works best for you? *Credit CardVenmoAnnual MembershipPrice: $ 325.00Senior MembershipPrice: $ 325.00Credit Card FeesPrice: $ 15.00Total$ 0.00Please contact president@forestparkpool.net if you have any questions. Credit Card Information *CardName on CardPay by Venmo This Venmo account is controlled the Forest Park treasurer, Jessica Steffensen. Use 3640 as the last four digits if needed. Submit Questions? Contact us or email president@forestparkpool.net