Membership Registration Form

"*" indicates required fields

Please fill out this form to create an account with Hasbrouck Heights Swim Club. All applications will be reviewed for approval prior to acceptance.

Account Information

Your Name*
Address*
This will be the username for your online account.
Password
This field is hidden when viewing the form

Family Members

Please enter the total number of people who will be using this membership including yourself. E.g.,: For yourself plus a spouse and one child enter 3. DO NOT INCLUDE OR LIST NANNY PASS (will be done when invoicing)
Spouse/Partner Name
Child 1
MM slash DD slash YYYY
Child 2
MM slash DD slash YYYY
Child 3
MM slash DD slash YYYY
Child 4
MM slash DD slash YYYY
Child 5
MM slash DD slash YYYY
Child 6
MM slash DD slash YYYY
ALL MEMBERS MUST BE FULL-TIME RESIDENTS AT YOUR LISTED ADDRESS. Please enter the member who you would like to request be added to the account, with name, DOB (mm/dd/yyyy) and relationship to you.

HASBROUCK HEIGHTS SPONSORS

HASBROUCK HEIGHTS RESIDENTS; PLEASE PROVIDE PROOF OF RESIDENCY ONLY. WOOD-RIDGE RESIDENTS; PLEASE PROVIDE ONE REFERRAL. ALL OTHER TOWNS; PLEASE PROVIDE THREE REFERRALS.
Referral #1
Referral #2
Referral #3
Referral #4
Referral #5
PLEASE UPLOAD PROOF OF RESIDENCY FOR ALL ADULTS ON YOUR MEMBERSHIP. UPLOAD PROOF OF EMPLOYMENT WITHIN THE BORO IF NOT RESIDENT OF HH
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