Online Pool Registration Form – Annehurst Village

Primary Member Information

Last Name *

First Name *

Gender * Gender

Email Address *

Phone (Primary) *

Type (Primary) *

Home

Work

Cell

Phone (Secondary) *

Type (Secondary) *

Home

Work

Cell

Address *

Youth Birthdate (If Applicable/Primary Member is Youth)

Prior Pool Member? *

Yes

No

If you choose NO, instead please complete the form available at the pool. You may need to join the AVRA as an associate member if you have not joined previously. If you choose yes, be aware that your standing in the AVRA will be verified, and if not current, you will need to get your AVRA standing current prior to pool membership being active.

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Neighborhood Information

Select Your Neighborhood *

Please Choose From Available Options

Other Neighborhood Name

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Annehurst Village Resident Section

Please Choose Your Address

Own/Rent

Own

Rent

Desired Membership Type

Family ($230)

Couple ($160) * Children aged 2 and younger included *

Single ($125)

Grandparent(s) ($175) * Grandkid(s) included *

Senior ($50 each) * 65 and Over *

PM Couple ($130) * After 5PM *

Also Interested In

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Non-Annehurst Resident Section

Desired Membership Type

Family ($290)

Couple ($160) * Children aged 2 and younger included *

Single ($125)

Grandparent(s) ($175)

Senior Single ($110) * 65 and Over *

Senior Double ($160) * 65 and Over *

PM Couple ($190) * After 5PM *

Also Interested In

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Additional Pool Members Information

#2 Last Name

#2 First Name

#2 Gender #2 Gender

#2 Youth Birthdate (If Applicable)

#2 Phone (Primary)

#2 Type (Primary)

Home

Work

Cell

#2 Relation to Primary Member

#2 Lives at Same Address?

Yes

No

#3 Last Name

#3 First Name

#3 Gender #3 Gender

#3 Youth Birthdate (If Applicable)

#3 Phone (Primary)

#3 Type (Primary)

Home

Work

Cell

#3 Relation to Primary Member

#3 Lives at Same Address?

Yes

No

#4 Last Name

#4 First Name

#4 Gender #4 Gender

#4 Youth Birthdate (If Applicable)

#4 Phone (Primary)

#4 Type (Primary)

Home

Work

Cell

#4 Relation to Primary Member

#4 Lives at Same Address?

Yes

No

#5 Last Name

#5 First Name

#5 Gender #5 Gender

#5 Youth Birthdate (If Applicable)

#5 Phone (Primary)

#5 Type (Primary)

Home

Work

Cell

#5 Relation to Primary Member

#5 Lives at Same Address?

Yes

No

#6 Last Name

#6 First Name

#6 Gender #6 Gender

#6 Youth Birthdate (If Applicable)

#6 Phone (Primary)

#6 Type (Primary)

Home

Work

Cell

#6 Relation to Primary Member

#6 Lives at Same Address?

Yes

No

#7 Last Name

#7 First Name

#7 Gender #7 Gender

#7 Youth Birthdate (If Applicable)

#7 Phone (Primary)

#7 Type (Primary)

Home

Work

Cell

#7 Relation to Primary Member

#7 Lives at Same Address?

Yes

No

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Misc Fees

Babysitter ($50)

Please provide Babysitter information below in Additional Pool Members Information Section

Number of Snack Cards

($20 each)

Number of Guest Punch Cards

($50 each) Good for 10 Passes / Regular Guest Admission is $8.00

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Membership Fee Section

2019 Pool Membership Fee (Includes $2.00 convenience fee)

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Payment Section

Credit Card

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