Wythe Pool
2027 Pool Membership Request
Choose Your Membership
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next
( X )
Family membership
$450.00
$
450.00
Two adults + up to 4 children 18 and under in the same household, OR one adult + 5 or more children.
Single membership
$200.00
$
200.00
Adult 18 and older
Single parent
$335.00
$
335.00
One adult + up to 2 children. (Extra children, $50 each. ADD BELOW.)
Child ADD-ON
$50.00
$
50.00
Single Parent memberships only. Required for each additional child age 3+. If adding more than 2 additional children, please select the family membership.
Quantity
1
2
Senior single (65 & up)
$170.00
$
170.00
Total
$0.00
$
0.00
Credit Card
Primary Member
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Who can be included?
(Names must be listed on the application to enter the pool.)
Family Membership:
Two adults plus children age 18 or younger who reside in the same household or a single parent and 5+ children.
Single Adult/Guardian + Child:
One adult plus up to two children. Additional eligible children must be purchased as add-ons.
Child Caregiver Exception:
Households with children under 12 may include one family child caregiver. The caregiver may use the pool only while caring for the children and must be listed by name above.
Spouse/Partner
First Name
Last Name
How many children will be included on this membership?
Please Select
0
1
2
3
4
5
6
7
8
9
10
Child 1
First Name
Last Name
Child 1 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child 2
First Name
Last Name
Child 2 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child 3
First Name
Last Name
Child 3 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child 4
First Name
Last Name
Child 4 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child 5
First Name
Last Name
Child 5 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child 6
First Name
Last Name
Child 6 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child 7
First Name
Last Name
Child 7 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child 8
First Name
Last Name
Child 8 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child 9
First Name
Last Name
Child 9 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Child 10
First Name
Last Name
Child 10 Age
Please Select
Under 1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Will you be including a child caregiver/babysitter on this membership?
YES
NO
Child Caregiver/Babysitter Name
First Name
Last Name
Submit
Should be Empty: