Country Glen Swim and Tennis Club

Member Type*
- New Member
- Returning Member
Account Type*
- Family
- Two Person
- Single
Member Directory
- Yes
- No
We will be adding an online member directory to our website this summer. If you would not like your contact info. to appear, please select no. The directory will ONLY be accessible to other members who are logged in. You will be able to change your status at any time.
Member Number
Returning members, if you know your membership number, please enter it here.
Primary Member Contact Info.
For family memberships, please enter the information for the head of household who will serve as the point of contact.
Member Name*
FirstLast
Home Phone*
Ex: 555-555-5555
Work Phone
Ex: 555-555-5555
Cell Phone
Ex: 555-555-5555
Email*
Alternate Email
Address*
Street AddressCityStateZip Code
Allergies / Medical Conditions
Spouse Information
For family memberships, please fill out the following information for the non-primary contact head of household, if applicable.
Spouse Name
FirstLast
Home Phone
Ex: 555-555-5555
Work Phone
Ex: 555-555-5555
Cell Phone
Ex: 555-555-5555
Email
Alternate Email
Allergies / Medical Conditions
Emergency Contact Info.
Please enter contact information for someone other than the party(ies) listed above who can be contacted in the event of an emergency.
Name*
FirstLast
Home Phone*
Enter as 555-555-5555
Work Phone
Ex: 555-555-5555
Cell Phone
Ex: 555-555-5555
Email
Child Information
Please select the number of children in your family and fill out the corresponding information fields. If they plan to be a member of the swim and/or diving teams, please select the appropriate checkboxes next to their information.
Number of Children
Child One
Name*
Date of Birth*
MM
DD
YYYY
Team Registration
Allergies / Medical Conditions
Child Two
Name*
Date of Birth*
MM
DD
YYYY
Team Registration
Allergies / Medical Conditions
Child Three
Name*
Date of Birth*
MM
DD
YYYY
Team Registration
Allergies / Medical Conditions
Child Four
Name*
Date of Birth*
DD
MM
YYYY
Team Registration
Allergies / Medical Conditions
Child Five
Name*
Date of Birth*
MM
DD
YYYY
Team Registration
Allergies / Medical Conditions
Child Six
Name*
Date of Birth*
MM
DD
YYYY
Team Registration
Allergies / Medical Conditions
Child Seven
Name*
Date of Birth*
MM
DD
YYYY
Team Registration
Allergies / Medical Conditions
Child Eight
Name*
Date of Birth*
MM
DD
YYYY
Team Registration
Allergies / Medical Conditions
Child Nine
Name*
Date of Birth*
MM
DD
YYYY
Team Registration
Allergies / Medical Conditions
Child Ten
Name*
Date*
MM
DD
YYYY
Team Registration
Allergies / Medical Conditions

Primary Member Contact Info.

Spouse Information

Emergency Contact Info.

Child Information

Child One

Child Two

Child Three

Child Four

Child Five

Child Six

Child Seven

Child Eight

Child Nine

Child Ten