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2017 Pool Information

THE HIGHLANDS POOL

THE HIGHLANDS POOL

2016 MEMBERSHIP INFORMATION FORM

NAME ___________________________________________________________________________

ADDRESS ________________________________________________________________________

HOME PHONE ___________________________ WORK PHONE __________________________

SPOUSE’S NAME _________________________________________________________________

CHILDREN LIVING WITH YOU:

CHILD’S NAME ____________________________________________ AGE _____________

CHILD’S NAME ___________________________________________ AGE _____________

CHILD’S NAME ___________________________________________ AGE _____________

CHILD’S NAME ___________________________________________ AGE _____________

PAYMENT SCHEDULE

Initiation Fee: $650.00

Membership Types:

1) Family Pool Membership – $510.00

2) Senior Couple Pool Membership – $345.00 – For Senior Couples Only

3) Club Member w/ Family Pool Membership – Add $38/mo to Club Dues for 12 months

4) Club Member w/ Senior Couple Pool Membership – Add $25/mo to Club Dues for 12 months

Senior Couple Pool Membership requires one spouse be a minimum of 55 years

old and submit a copy of his/her photo drivers license for first time qualification.

If dues are not kept current, membership will automatically be terminated.

In order for membership to be reinstated, the $650 initiation fee must be re-paid.

I understand the $650 initiation fee is non-refundable and my membership is not transferable. I

understand that by signing this application I agree my family, my guests and I will abide by the Pool

Rules.

SIGNED ___________________________________ DATE _________________

Membership applications must be completed in their entirety and returned with the signed waiver form

(if applicable) For pool members payment is due in full by May 10, 2016. All Pool members including

Club Members with Pool must complete an application and return to Donna Castleberry or The

Country Club at The Highlands.

Pool Contact: Country Club at The Highlands Contact:

Donna Castleberry Susan Kirwan

7319 Rosemead Lane 8136 Highland Glen Drive

Chesterfield, VA 23838 Chesterfield, VA 23838

748-0755 796-4800 Ext. 317