DEEPDALE GARDENS COMMUNITY COUNCIL, INC.

Application for New Membership in Community Center Program 2012

 

Rates are $450.00 Per Adult Member / $250.00 Per Child (ages 3-17) Member.

Name
Street Address
Address (cont.)
City
State
Zip
Work Phone
Home Phone
Cellular Phone
E-mail

I hereby agree to all statements made in the application for Membership for 2011 and agree to be bound by the Center's Rules & Regulations and understand that I am obligated to make payments due as required in the Schedule of Fees \ Please visit REGULATIONS before submitting this application for a complete copy of the Pool Rules

 

Primary Member @ $450.00

Name
Date of Birth
Relationship

Additional Persons on Membership @ $450.00 Adult - $250.00 Child

Name
Date of Birth
Relationship

Additional Persons on Membership @ $450.00 Adult - $250.00 Child

Name
Date of Birth
Relationship

Additional Persons on Membership @ $450.00 Adult - $250.00 Child

Name
Date of Birth
Relationship

Additional Persons on Membership @ $450.00 Adult - $250.00 Child

Name
Date of Birth
Relationship

THE CENTER RESERVES THE RIGHT TO REQUIRE PROOF OF RESIDENCY UPON APPLICATION OF MEMBERSHIP
Member of Deepdale Gardens Community Council, Inc. for the 2010Season	Yes	No
Lounge Rack Rental @ $15.00 for the season	Yes	No
Deck Chair Rack Rental @ $15.00 for the season	Yes	No
Locker Rental 1/2 Sized @ $10.00 for the season	Men	Women
Locker Rental Full Sized @ $15.00 for the season	Men	Women
Health Information
For your family's protection please submit the name of any family member who has a medical condition that might require emergency medical treatment: i.e. epilepsy, diabetes, heart condition, etc. Any information that you provide will be treated in the utmost confidence.