WVSRC 2022/2023 Emergency Contact Form

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WVSRC 2022/2023 Emergency Contact Form

In compliance with our Pool Management contract, an Emergency Contact must be submitted by every membership prior to admittance into the pool area.

Medical information is not a requirement and is submitted voluntarily.

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* Indicates required question

Household Last Name *

The last name of the Membership Account Holder

Your answer

Household Address *

The home address aligned with your membership for identification purposes only

Your answer

Primary Phone Numbers *

Numbers that are best to reach you

Your answer

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