Join the Pool

To join our wait list please complete the form below.

Waitlist

Date of Application:*
MM slash DD slash YYYY
Billing Contact Name*
Enter the name of the person who should be contacted regarding any questions about the account.
First Last
Address*
Street Address City State ZIP Code
Occupation:*
Employer:*
Spouse Name:
Spouse Phone:
Spouse Employer:
Please list Children (under 21) with their DOB
A regular membership may only be issued to the head of household. A household is defined in the PRNSC bylaws as a family permanently living together consisting of a head of household, spouse, all unmarried children who have not turned 21 by July 1 of the current year, and all adult dependents living in the household who are not self-supporting because because of a permanent disability. Associate memberships are available to children of the household that are over the age of 21, a mother, father or mother-in-law or father-in-law not gainfully employed and living permanently with the regular member.
Phone*
Email*
Username*

This is what you will use to log into your waitlist account.
Password*
Enter Password Confirm Password

Strength indicator

Select a password that you will use to access your account. You will be able to send a password reset link to the email address you entered above if necessary.
1. Identification:*
Accepted file types: jpg, jpeg, png, gif.
Please upload a photocopy of a picture identification for example a driver's license.
2. Proof of Residency:*
Max. file size: 10 MB.
Please provide two forms of proof of residency in the form of bills that include your address within the Pearl River Fire District or Pearl River School District. Examples include: tax bill, utility bill, water bill or phone bill.
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
3. Waitlist Fee*
Price:
Wait list fee: $75.00+ tax (8.375%)
Convenience Fee*
Price:
Total
$0.00
CAPTCHA
Terms of Service*
I hereby apply for membership in the Pearl River-Nauraushaun Swim Club, Inc. I certify that I am at least 21 years of age and reside at the address shown above which is in the Pearl River Fire District or Pearl River School District. I understand that upon receipt of this application, proof of residency, and payment for $81.28, my name will be placed on a list of potential members. I understand that the waiting list may exceed three years. I understand that my wait list payment fee is non refundable. It is my responsibility to keep the Club informed of any change in my address, phone number or email address.
- I agree to the Terms of Service
Comments
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Join the Pool

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