Forest Hollow Swim Club

1
Forest Hollow Swim Club MEMBER REGISTRATION and
EMERGENCY DATA FORM - 2007 Please complete this
form and return with check made payable to FHSC
by May 1 to Jonathan Lash, FHSC Membership,
6539 Oakwood Drive, Falls Church, Virginia
22041 Note A late fee of 25 must be added after
May 1 Circle Type of Membership Shareholder
Summer ½ Summer ½
Summer Inactive 380
450 325 325 50
May 26th-July 14 July 15-Sept 3
Any questions concerning membership or if you
are interested in purchasing a pool share please
contact Jonathan or Betty Jo Lash
571-481-1053 Family Name_______________
Address__________________________________________
Home Phone______________________________ Email
Address_____________________ PRINT EACH FAMILY
MEMBERS NAME THAT IS LIVING AT ABOVE ADDRESS.
EMERGENCY CONTACT INFORMATION IS
CRITICAL. I hereby authorize the lifeguard
staff of NVPools, Inc. to obtain emergency
medical care for injuries or illness for my child
that might occur while at the pool facility. I
direct all medical facilities to accept this
document as authorization to render essential
medical care necessary in the event of an
emergency and I am unable to be immediately
contacted. ________________________________
_______________ Signature
Date Health Insurance
Carrier___________________________Policy_________
_____