Name ______________________________

Address ____________________________________
State/Zip ___________________________________
Phone _____________________________________
Emergency Phone # ___________________________

Employer ___________________________________
Occupation _________________________________

Spouse’s Name ______________________________
Employer ___________________________________
Occupation __________________________________

Children : ______________________ Age _______
______________________ _______

______________________ _______
______________________ _______

Please select payment plan on reverse side of this form. Return this form and payment to Walnut Grove Swim Club, c/o Kathy Korty, 601 Westview Ave. Trenton, Ohio 45067 or call Kathy for more information, 988-9048.

I, the undersigned, make application for membership into the Walnut Grove Swim Club. If accepted, I agree to abide by its constitution, laws, general rules and regulations, and any special rules of health and safety so imposed by the pool staff and/or the executive board. I also agree to make all play payments in consecutive years (1, 2, 3) and am aware that membership fees are non-refundable. I realize that all membership fees and dues for the year must be made in full prior to using the club facilities.

___________________________ __________

Applicant’s Signature Date

New Member Walnut Grove 2008

PO Box 33

Trenton, Ohio 45067

Name ____________________________

Address __________________________

City/State/Zip ______________________

Total Paid: ________________________

Circle One: Check Cash

Walnut Grove Pricing Options:

Current Members

Family Voting Membership

3 year Family Voting Payment Plan

Single Voting Member

3 year Single Voting Payment Plan

$245

$395/ Payment becomes $245 after 3 years

$125

$240/ Payment becomes $125 after 3 years

New Member Options

Family Voting Membership Payment Plans

Single Voting Membership

Summer Family Membership

Summer Single Membership (Age 10 and up)

(1yr) $645 (2yrs) $455 (3yrs) $395

At the end of plan, dues will be same as Voting Family membership

(1yr) $425 (2yrs) $385 (3yrs) $240

At the end of plan, dues will be same as Voting Single membership

$295

$150

New This Year

Family Package: Holidays and Weekends Only

$150

Supplemental Add-ons to your membership

Babysitter (Must be age 14 or older)

Child you baby sit daily (Must be under the age of 10) (Limit 3/membership)

Grandchild (Must be under the age of 10)

$50

$50/Child