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Membership request form
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Which membership are you requesting?
Are you a Cleveland Heights resident?
Yes
No
*
First name
*
Last name
*
Email
*
Phone
*
Address
*
When would you like your membership to begin?
*
Name & DOB of all children attending
*
Please provide 2 emergency contacts with name and number included.
*
Does your child have any allergies, dietary restrictions or special needs?
No
Yes
*
If answered "yes" above, please explain in detail or type "NA"
Is there anything else we should know to help us safely and comfortably care for your child?
*
Authorized pick up
Please list any authorized pick up persons for your child. Must be 18+ and present ID.
*
Acknowledgements
I understand that submitting this form is a membership request, not a payment or guarantee enrollment.
I understand that memberships must be approved and payment confirmed before my membership is activated.
I understand that membership care is subject to available spots and FUNcare policies.
I understand that a $10 sibling fee applies per booking when additional enrolled siblings attend the same booking.
I understand that the Cleveland Heights discount is subject to verification.
I certify that the information provided in this form is accurate and complete.
*
Signature
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