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East Ridge Youth Foundation
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Online Membership Form


First Name Primary
Last Name Family Name
Street Address  
City  
State  
Zip  
Primary Phone (234) 567-8901
Secondary Phone  
Fax  
Email  
Emergency Contact Name & Phone
Different from Primary Phone Number

List EACH Family Member, Including yourself (Primary)

First & Last Name Primary
First & Last Name Family Member
First & Last Name Family Member
First & Last Name Family Member
First & Last Name Family Member
First & Last Name Family Member
First & Last Name Family Member
First & Last Name Family Member
First & Last Name Family Member

Were you a member Last Season?  Y/N

Send Additional Information or Questions:

Please Note!

A Family consists of a responsible adult and other persons living at the same address who are classified as dependents according to the Internal Revenue Service guidelines.  Grandparents, cousins, friends, roommates, etc… may NOT be included as family members for membership purposes unless dependent status is met

Proof of dependent status may be required. A Baby sitter or child care person may be added to a family application to supervise children under 12 years of age. There is no additional fee for non-swimming caregivers. Caregivers who desire to swim may be added with an additional fee, but pool privileges will be limited to the hours that they are actually on duty.

AGREEMENT: I certify that the above information is correct and that I have read and understand the information contained in the application. I assume responsibility for members of my family to abide by the rules and regulations, policies, and procedures of the East Ridge Youth Foundation. I understand that the infraction of these rules may result in loss of my membership without a refund. I further understand that I may be required to verify dependent status as defined by the Internal Revenue Service.

<<<Primary Member INITIALS,  By Initialing this box, you, (Primary Member) agree with the terms and conditions outlined above.