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