GARDEN CITY SWIM CLUB - DOC

							                                  HAYMAKER SWIM CLUB
                              2012 MEMBERSHIP APPLICATION
I (We), the undersigned, hereby submit this application for membership in the Haymaker Swim
Club and agree to abide by all rules, regulations, and by-laws of the Club.

Type of Membership (Please select one):

______Family                                     $255
______Individual (must be 18 years or older)      $160

Last Name_______________________ First___________________ Spouse________________

Address________________________________             Home Phone #________________________
        _________________________________           Work Phone # ________________________

E-Mail Address*___________________________ Cell Phone #_________________________
*Please provide at least one email address to receive important announcements, reminders, and
upcoming newsletters!
Children’s Names and Ages:
_______________________ ____________              _______________________ ____________
_______________________ ____________              _______________________ ____________

Emergency Contact (Name & Phone #): ____________________________________________
I am a new member and I was referred by: ___________________________________________

_____Yes, I would like to purchase one packet of 10 guest passes. I have included $25.00 with
     this application.
The applicants shall be entitled to a full club membership for the 2012 season and shall be
entitled to all the privileges associated therewith. By signing below, on behalf of those named on
this application and any of our guests, I release the Haymaker Swim Club, the Board of
Directors, pool management, pool staff, and the pool members from any and all liability for any
injury or damages resulting from any and all use of Haymaker Swim Club facilities. I also give
permission for Haymaker Swim Club to post images of all family members and guests in
newsletters and the swim club’s website.

Applicant’s Signature_______________________________________ Date_______________

CHECKS PAYBLE TO:                       Haymaker Swim Club
                                        c/o Stephanie Reilly
                                        101 Aquillin Court
                                        Irwin, PA 15642