GRAL Swimmer/Employee Exemption Form
Year
*
Club Name
*
Please Select
ASHCREEK
ASHLAND
ATLEE
BATTLEFIELD GREEN
BELL CREEK
BURKWOOD
CANTERBURY
CHESTNUT OAKS
CHURCH RUN
COLONIES
FOX HALL
GOOCHLAND YMCA
HANOVER
HUNGARY CREEK
KINGS CHARTER
MECHANICSVILLE
MILESTONE
OLD CHURCH
PEBBLE CREEK
RAINTREE
ROCKVILLE/DOLPHIN CLUB
THE DOMINION CLUB
THE FEDERAL CLUB
TUCKAHOE VILLAGE WEST
TWIN HICKORY
WELLESLEY
WEMBLY
WYNDHAM
Swimmer Name
*
Swimmer Age
*
Swimmer Gender
*
Female
Male
Date of Employment
*
Swimmer's Job Title
*
Was the swimmer previously a member of your swim team?
*
Yes, last year
Yes, but not last year
No
If swimmer was with another team last year, what was the name of the team:
Is the swimmer currently a member in good standing of your club? Note: If membership is a benefit provided to ALL employees, the answer is yes.
*
Yes
No
Name of Person filling out this form
*
First Name
Last Name
Role with club
*
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Anything else you want to tell us?
Submit
Should be Empty: