GWRAAppCreditCard

George Wythe Recreation Association (G.W.R.A.)

2023 Pool Membership Application
Select Membership Type (Complete and print this form to send it with payment)

Family Membership $375.00 (2 Adults + 1-4 Children) – May only include immediate family members residing full-time in the same household.Family Membership $410.00 (2 Adults + 5 Children) – May only include immediate family members residing full-time in the same household.Family Membership $445.00 (2 Adults + 6 Children) – May only include immediate family members residing full-time in the same household.Family Membership $480.00 (2 Adults + 7 Children) – May onlyinclude immediate family members residing full-time in the same household.Family Membership $515.00 (2 Adults + 8 Children) – May onlyinclude immediate family members residing full-time in the same household.Adult + 1 Child $210.00Adult + 2 Children $245.00Single Membership $175.00
Primary Member/Contact*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Additional Members
- Family Membership: May only include immediate family members residing full-time in the same household. Exception- Members with children under the age of 12 years old may include ONE family child caregiver in their family membership. This person must be listed by name below and may only use the facility while watching the children.
- Single: Use this section if you are paying for more than one single membership.
- Adult + Child: Use this section to list up to two (2) children. Exception- You may include ONE family child caregiver in their family membership. This person must be listed by name below and may only use the facility while watching the children.
Please verify that you are human*
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George Wythe Recreation Association (G.W.R.A.)