This is an Application for:
Family MembershipIndividual Membership
New MembershipRenewal

Primary Member Full Name(required)

Primary Member Email (required)

Phone

Address

Address 2

City
FremontMilpitasNewarkSan JoseHaywardNewarkUnion CityOakland
State
CA
ZIP

Date of Birth

Other Members

Member 1
Full Name

Member 1 Date of Birth

Relationship to Primary Member

Member 1 Email

Member 2
Full Name

Member 2 Date of Birth

Relationship to Primary Member

Member 2 Email

Member 3
Full Name

Member 3 Date of Birth

Relationship to Primary Member

Member 3 Email

Member 4
Full Name

Member 4 Date of Birth

Relationship to Primary Member

Member 4 Email

Associate Members
Non-Permanent resident who uses the facilities (i.e., nannies, caregivers, etc.)
Full Name

Member Date of Birth

Relationship to Primary Member

Associate Member Email

Other Members

Emergency Information

Doctor/HMO Name

Doctor/HMO Phone Number

Emergency Contact Name (Adult)

Emergency Contact Phone Number

Emergency Contact Name

Emergency Contact Phone Number

I will submit a payment in person by cash or checkI will make a payment online (subject to 3% convenience fee)

I HAVE READ AND CONFIRM ALL THOSE COVERED UNDER THIS MEMBERSHIP UNDERSTAND THE WSCC GENERAL POOL RULES AND WILL ABIDE BY THEM.