Babysitter Pass Application – Pearl River Nauraushaun Swim Club

Babysitter Form

"*" indicates required fields

Membership #

Billing Contact Name*

First Last

Address*

Street Address City State ZIP Code

Phone*

Email*

The email address we will use to contact you.

Babysitter Name

Babysitter Phone

Babysitter Fee

Price:

$100.00 (plus tax)

Processing Fee

Price:

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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Babysitters (MEMBER ASSUMES RESPONSIBILITY) are permitted only in place of parent(s). Babysitters must be at least 15 years of age, attested to in writing by the head of the household. Babysitters are to leave the club grounds when the parent(s) arrive.

I agree to the Terms of Service

Babysitter Form

"*" indicates required fields

Membership #

Billing Contact Name*

First Last

Address*

Street Address City State ZIP Code

Phone*

Email*

The email address we will use to contact you.

Babysitter Name

Babysitter Phone

Babysitter Fee

Price:

$100.00 (plus tax)

Processing Fee

Price:

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

CAPTCHA

I agree to the Terms of Service

Babysitter Form

Babysitter Form

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