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Swim Club Membership Application

Swim Club Application

Swim Club 2020 Memembership Application

Please complete the form to finalize your membership.

Swim Club 2020 Membership Form
Contact Information
*Name*
*First Name *Last Name
Address*
*Address Line 1 Address Line 2 *City *State *ZIP
*Date of Birth*
*Date of Birth
Date Format: 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
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.
Membership Type*
*Membership Type
- Household $325
- Individual $225

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
Date Format: 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
Date Format: 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
Date Format: 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
Date Format: 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
Date Format: 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
Date Format: MM slash DD slash YYYY
Email
Email (if different from household)
Phone
Phone (if different from household)

TERMS OF ACCEPTANCE and SIGNATURE
Check each box to indicate your agreement with the following policies:
I will abide by the rules of use at Pearlstone Campus.*
I will abide by the rules of use at Pearlstone Campus.
- YES
I am responsible for payment in full prior to usage of Pearlstone Campus pool and facilities.*
I am responsible for payment in full prior to usage of Pearlstone Campus pool and facilities.
- YES
Membership fees are nonrefundable and nontransferable.*
Membership fees are nonrefundable and nontransferable.
- YES
I understand Pearlstone urges all members and their guests to swim within their limits. It is the responsibility of the member to exercise cautious behavior when undertaking any physical activity.*
I understand Pearlstone urges all members and their guests to swim within their limits. It is the responsibility of the member to exercise cautious behavior when undertaking any physical activity.
- YES
I understand Pearlstone reserves the right to close its pools and facilities for inclement weather, government-enforced state of emergency, or for private events.*
I understand Pearlstone reserves the right to close its pools and facilities for inclement weather, government-enforced state of emergency, or for private events.
- YES
I understand my membership may be suspended or terminated for any act or behavior deemed by Pearlstone as unacceptable.*
I understand my membership may be suspended or terminated for any act or behavior deemed by Pearlstone as unacceptable.
- YES
Pearlstone reserves the ability to search person and property.*
Pearlstone reserves the ability to search person and property.
- YES
Pearlstone reserves the right to perform a background check on any member or prospective member where deemed appropriate.*
Pearlstone reserves the right to perform a background check on any member or prospective member where deemed appropriate.
- YES
Pearlstone reserves the right to request a driver's license or other valid photo ID for all persons applying for membership.*
Pearlstone reserves the right to request a driver's license or other valid photo ID for all persons applying for membership.
- YES
I understand that regular searches of the National Sex Offender Public Registry (www.nsopr.gov) and/or the State of Maryland Sex Offender Registry (www.dpscs.state.md.us) will be conducted for all applicants and members and any person identified in either registry shall be denied membership.*
I understand that regular searches of the National Sex Offender Public Registry (www.nsopr.gov) and/or the State of Maryland Sex Offender Registry (www.dpscs.state.md.us) will be conducted for all applicants and members and any person identified in either registry shall be denied membership.
- YES
By my signature below, I release, hold harmless, and indemnify Pearlstone as well as its agents and employees, from and against any liability on their part, of any kind whatsoever, which may arise in any manner whatsoever, from my use of the facilities.*
By my signature below, I release, hold harmless, and indemnify Pearlstone as well as its agents and employees, from and against any liability on their part, of any kind whatsoever, which may arise in any manner whatsoever, from my use of the facilities.
- YES
My permission is given to use any photographs and videos taken of me at the facility for publicity.*
My permission is given to use any photographs and videos taken of me at the for publicity.
- YES
*Electronic Signature
I acknowledge that I have carefully read this application for membership, that I fully understand its contents, and that my release of Pearlstone and its agents, and employees from liability is my voluntary act and is freely made. I, the applicant for this membership, warrant the truthfulness of the information provided in this application. PLEASE TYPE YOUR FIRST AND LAST NAME
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.*
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.
- YES

Pearlstone The Associated

5425 Mt. Gilead Rd., Reisterstown, MD 21136
410-500-5417 | info@pearlstonecenter.org
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