Greenbrier Pool Membership Form

Full Name *

First Name Last Name

Name On Account

First Name Last Name

Phone Number Home *

Area Code Phone Number

Phone Number Cell

Area Code Phone Number

E-mail *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Please List ALL Family Members Permanently Residing In The Residence.
First Name   Last Name   Age
First Name   Last Name   Age
First Name   Last Name   Age
First Name   Last Name   Age
First Name   Last Name   Age
First Name   Last Name    Age

BABYSITTER INFORMATION: For family membership, a babysitter may be used to watch children under 14 years of age, and may only attend the pool to watch the child/ren in lieu of parent(s) or guardian(s), NOT in addition to parent(s) or guardian(s). Baby sitters must be at least 16 years of age. Please see Rules and Regulations for additional information.

Add Babysitter Info:
First Name Last Name Area Code Phone Number
First Name Last Name Area Code Phone Number

Greenbrier Pool is a private, members-only club. All membership applications (new or returning) are subject to the approval of the Board of Directors. The Board of Directors reserves the right to deny and/or revoke memberships based on material misrepresentations contained herein, violations of the Rules and Regulations, and/or for conduct deemed unacceptable by the pool membership and/or Board of Directors. I hereby certify that the foregoing information is true and accurate and understand that any misrepresentations contained in the foregoing Application are grounds for refusal or and/or revocation of membership at Greenbrier Pool. By my signature, I agree that I have reviewed and will abide by all Rules and Regulations of Greenbrier Pool and understand that my membership may be denied and/or revoked as indicated above.

Please verify that you are human *

Date *