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.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:FirstLastNextMembership InformationName - Primary Member *FirstLastName - Secondary MemberFirstLastHow many additional family members will be on your account? *012345678Family Member (1)FirstLastBirthday 1MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Member 1Family Member (2) FirstLastBirthday 2MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Member 2Family Member (3)FirstLastBirthday 3MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Member 3Family Member (4)FirstLastBirthday 4MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Member 4Family Member (5)FirstLastBirthday 5MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Member 5Family Member (6)FirstLastBirthday 6MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Member 6Family Member (7) FirstLastBirthday 7MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Member 7Family Member (8)FirstLastBirthday 7MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*required if member is a minorRelationship to Member 7PreviousNextInsurance & 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 *MM123456789101112/DD12345678910111213141516171819202122232425262728293031/YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Signature *Clear SignatureAnnual MembershipPrice: $ 3.00Credit Card FeesPrice: $ 0.50Total$ 0.00Credit Card Information *CardName on CardSubmit