Swim Club Member Application

Swim Club 2022 Membership Application

Our Membership for Summer 2022 is currently open to renews only. Any new applications will be added to the wait list. Waitlisted people will be placed in any empty spots available after the renewal period.

MEMBER CONTACT INFORMATION:
*Name*
*First Name *Last Name
Address*
*Address Line 1 Address Line 2 *City *State *ZIP
*Date of Birth*
*Date of Birth
MM slash DD slash YYYY
*Phone 1*
*Phone 1
Phone 1 type*
*Phone 1 type
Phone 2
Phone 2
Phone 2 type
Phone 2 type
*Email*
*Email
Emergency Contact Info*
*Emergency Contact Info: Relative/friend not part of your household. Preferably someone who lives in the area

MEMBERSHIP SELECTION:
Returning vs. New*
*I am a:
- Returning Member
- New Member
Membership Type*
*Membership Type
- Household $350
- Individual $250
How did you hear about us?*
*How did you hear about us? If you were referred by a current Swim Club member, please write their name here.

Number of Members in Household (include self as 1)*
*Number of Members in Household (include self as 1)
Please enter a number from 2 to 8.
Household Member #2:
Name**
*First *Last
Date of Birth*
*Date of Birth
MM slash DD slash YYYY
Email
Email (if different from household)
Phone
Phone (if different from household)
Is there another member in your household? A*
*Is there another member in your household?
- Yes
- No

Household Member #3:
Name**
*First *Last
Date of Birth*
*Date of Birth
MM slash DD slash YYYY
Email
Email (if different from household)
Phone
Phone (if different from household)
Is there another member in your household? B*
*Is there another member in your household?
- Yes
- No

Household Member #4:
Name**
*First *Last
Date of Birth*
*Date of Birth
MM slash DD slash YYYY
Email
Email (if different from household)
Is there another member in your household? C*
*Is there another member in your household?
- Yes
- No

Household Member #5:
Name**
First* Last*
Date of Birth*
*Date of Birth
MM slash DD slash YYYY
Email
Email (if different from household)
Phone
Phone (if different from household)
Is there another member in your household? D*
*Is there another member in your household?
- Yes
- No

Household Member #6:
Name*
*First *Last
Date of Birth*
*Date of Birth
MM slash DD slash YYYY
Email
Email (if different from household)
Phone
Phone (if different from household)
Is there another member in your household? E*
*Is there another member in your household?
- Yes
- No

Household Member #7:
Name*
*First *Last
Date of Birth*
*Date of Birth
MM slash DD slash YYYY
Email
Email (if different from household)
Phone
Phone (if different from household)

From Our Farm to Your Table

Did you know? Pearlstone Kitchen Fresh Meal Delivery Service brings dinner to your door. Let us do the cooking!

PEARLSTONE KITCHEN MENU

Our membership for 2022 is currently open to renewals only. For new applicants, please fill out the application form in its entirety above first to be added to the wait list. DO NOT process payment yet, it takes 6 to 8 weeks to receive a refund. You will be informed directly by Lee Fenner if a spot opens up and he will instruct you to process your payment using the form below to finalize membership:

Swim Club Member Application

Swim Club 2022 Membership Application

MEMBER CONTACT INFORMATION:

MEMBERSHIP SELECTION:

Household Member #2:

Household Member #3:

Household Member #4:

Household Member #5:

Household Member #6:

Household Member #7:

TERMS OF ACCEPTANCE & SIGNATURE

From Our Farm to Your Table