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2. Primary Member Information
4. Last Name*
5. First Name*
7. Primary Phone Number*
8. Secondary Phone Number
10. Email Address*
12. Address *
14. City*
15. State*
16. Zip*
18. Hold Request & Policy
20. 2. Hold requests require a 15-day notice. Holds requested with less than a 15-day notice will be processed in the order received, which may occur after the next draft date. The $15 per month hold is waived at this time.
22. Hold to be effective for (please check one):*

    1. 1 month
    2. 2 months
    3. 3 months

24. Hold Policy: The 15-day notice and $15 per month hold fee are being waived at this time. A membership may be placed on hold for a maximum of three months each year. 

    DRAFTED MONTHLY: Hold begins and ends on the current draft date (1st or 15th of month). ANNUAL MEMBERSHIP: Hold begins and ends on the 1st of the month.

26. Start Month*
    -- Select One --JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
27. Start Date*
    -- Select One --1st15th
29. Membership Type (Check all that apply)*

    1. Adult
    2. Family
    3. Youth/Teen

    1. Special Hours
    2. Special Hours Couple
    3. Adult Plus*
31. *List each Adult Plus or Splash Aquatics member under your account.
33. Reason for Hold*
    -- Select One --COVID-19Temporary RelocationFinancialTravel/VacationSchedule ChangesSenior Programs UnavailableSplash Season PauseKids Club ClosureOther (please describe below)
35. Other Reason for Hold
37. Confirmation
39. Comments
41. Acknowledgement Required: *

    1. I understand the CRC is placing my membership on hold for the time period requested above.
    2. I acknowledge that my membership dues will not be charged during my membership Hold. The monthly draft for my membership dues will resume at the next draft date following the end of the Hold period
    3. I understand that my membership billing will automatically resume at the end of the hold period requested above.
43. Member Signature*
    Please type name to sign.
45. Please include date and time
    Please include date and time

    Please include date and time
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field