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JOIN GREEN MEADOWS POOL TODAY!

2018 FAMILY DATA FORM – PLEASE PRINT FORM AND FILL OUT COMPLETELY
Please mail the completed form with your check for appropriate fees and dues to: Green Meadows Park
c/o Kasey Gillham, 2524 E Greenwood, Springfield, MO 65804. Make checks payable to Green
Meadows Park Inc. For any other arrangements please contact Kasey at kasey.gillham@gmail.com
Or 417-838-3444. Please do not send cash in the mail!

Name:______________________________Address: _________________________________________

Spouse:_____________________________City/State/Zip:_____________________________________

Home Phone:________________________ Work Phone:_______________________________________

Cell Phone:__________________________Email (important!) __________________________________

Please list any children living in your home who will be attending the pool – no more than two adults
over the age of 21.

Child:_____________________Age:_____ Payment Enclosed: Check all that apply. Due by May 1st.

Child:_____________________Age:_____ _____ Annual Membership Dues

Child:_____________________Age:_____ _____ $50 One-Time New Member Heater Surcharge

Child:_____________________Age:_____ _____ Donation:________________________

Child:_____________________Age:_____ Total Amount Enclosed: _________________________

(Use additional sheet for more names) Cash______Check______Check #________Date________

_____Please check here if you DO NOT want your child’s/children’s photos used on our GMP website.

Membership Fee and Annual Dues Explained:


Membership Fee: $200. The membership fee is a one-time fee paid to become a member of the pool.
Membership Fee is waived for 2018!!!!!
Annual Dues:*
* Beginning in 2017, there is an additional one-time fee of $50 for NEW
members to be used toward the cost of operating our new heater.
Family - $350.00 -- all members of a family living in the same house with no more than 2 members who are
over the age of 21.
Couple - $250.00 – two adults or one child and one adult (if the child is under 11 the parent must be present
when the child attends the pool). A specific parent and child must be designated as the GMP members.
Single: - $150 – one adult over the age of 18.
Other Fees: Guest Fee - $3.00 per person per day, must be accompanied by member.
Guest Pass Punch Card - $20 for 10 punches. Punch Cards sold in the Frog Shack.
For any other arrangements please contact Kasey Gillham, Membership Director, by email or phone listed above.
Green Meadows Pool may be reserved for private parties before and after regular pool hours. Please contact a
board member for further information or to make a reservation.

Revised 05/01/2018

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