Barclay Farm Swim Club
Membership Application

Family Name: ________________________________________

Address: ____________________________________________

Phone: ______________________________________________

Email: ______________________________________________

Family Members**: _____________(adult) _____________(adult)

_______________(child/age) _______________(child/age)   _______________(child/age)

(**Entire Family unit must join.)

Payment: $ __   Bond: $ __   Initiation: $      0       __   Total Enclosed: $__________

(Please make checks payable to: Barclay Farm Swim Club)

Referred by:________________________________

Check here if new member:________

Return to:
Barclay Farm Swim Club

P.O.Box 1513

Cherry Hill, NJ 08034