Card applying for:
(Check one)

______ Membership (Address must be within the Maumee corporation limits, Maumee
             School District, or non-resident employee of the City of Maumee).

_______ Non-Resident Membership (Address must be outside Maumee corporation
               limits)

_______ Resident I.D. Card (Address must be in Maumee corporation limits or School
               District)

Last Name: ___________________________ First Name: ______________________

Address: ______________________________________________________________

City, State and Zip: _____________________________________________________

Phone Number: _______________________

Please list all children 6 years and older who live at the above address (family members you wish to purchase ID cards or membership cards for).

Name: _______________________ Date of birth: _______________ Age: _________

Name: _______________________ Date of birth: _______________ Age: _________

Name: _______________________ Date of birth: _______________ Age: _________

Name: _______________________ Date of birth: _______________ Age: _________

Signature of applicant: _________________________________________

To be filled out by Pool Staff:

Verified by list or City of Maumee: ____ Yes ____ No

                                                                                                Initials ___________