Southampton Recreation Association
Membership Application
Print this form and mail with payment  to Southampton Recreation Association,
3201 Chellowe Road, Richmond, VA 23225 (804)-272-7401

General Information

First and Last Name(s): __________________________________________________________

Home Address: ________________________________________________________________

City: _____________________________________Zip Code:__________

Home Telephone:______________________

Name__________________________  E-mail Address__________________________________

Spouse name____________________  E-mail Address__________________________________

Employment Information

Occupation____________________________ Office Phone________ Cell Phone_______________

Spouse Occupation______________________ Office Phone_________Cell Phone_______________


Family Information

Children's Names                                      Dates of Birth                            Age

1________________________________________________________________

2_________________________________________________________________

3_________________________________________________________________

4_________________________________________________________________

5_________________________________________________________________

6_________________________________________________________________

7_________________________________________________________________

(use back of form if more space is needed)

Other Household Members

Name                                                 Relationship

1_____________________________________________________________________

2_____________________________________________________________________

Do you have a full-time sitter/nanny during the summer?____________________________


Emergency Information

In case of emergency contact:_______________________________________________
Phone:________________________________________________________________

Physician(s) /Phone(s)

___________________________________________________________________

___________________________________________________________________

Please check the facilities and activities you may be interested in:

Swimming:  Youth Swim Team___  Swimming Lessons___  Early AM Adult lap swim_____

Tennis:  Adult tennis ladder___  Adult tennis socials___  Tennis lessons________

Ice Rink:  Skating Lessons____  Youth Ice Revue____  Youth Hockey_____

Summer Children's Camps (indicate any specific interests)______________________________

Socials:  Family Nights___  Kid's Float Nights___ Pub Nights/Adult Socials___

Basketball_____ Clubhouse Rental______
 

Please Indicate the SRA Committee you would be interested in volunteering for:

Pools:__________________________ Tennis:_______________________

Grounds:________________________ Ice:____________ Swim Team:____________

SRA Workdays (no experience necessary)  Spring____ Fall_____

How Did you learn about us?

Neighbor/Friend:____________________  Poster:__________________

Mailbox flyer:_______________________ Other (please specify)___________________
 

I/We do agree to abide by the Bylaws and Standing Rules of the Southampton Recreation association, a copy of which is acknowledged upon receipt of membership.

Signature*_____________________________________________ Date:_____________________

               ______________________________________________Date:_____________________

              ______________________________________________Date:______________________

             ______________________________________________Date:_______________________

* All household members over 18 are required to sign.

Welcome to the Southampton family! We're glad you're here!
http://sra-fun.org