Aqua Club
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Member Household Change Request

Membership Household Change Request

Use to request addition or deletion of a Club Member* from membership household

This field is hidden when viewing the form
*Please remember, "Club Member" is formally defined in our Aqua Club Bylaws, Section 2.2.1, and includes the following persons living at the same permanent address: The individual named in the certificate of Club Membership, His or her spouse residing in the same house, and Each dependent child residing in such individual's house. A dependent child away from the house attending school or for military service will still be considered part of the household if they still customarily live in the household. But a married child living in a household is not considered a dependent and must apply for a separate membership to use the club. It is each member’s responsibility to accurately identify Club Members and update Aqua Club of changes to Club Members in a household. Failure to comply with Aqua Club Bylaws or other rules and regulations, including identifying persons as Club Members who are outside the definition in the Aqua Club Bylaws, may result in suspension and/or expulsion and forfeiture of membership.
MM slash DD slash YYYY
Address(Required)
Max. file size: 5 MB.
NAME, BIRTHDATE, AND PHOTO are REQUIRED for each household member

Type of Household Member #1(Required)
MM slash DD slash YYYY
Max. file size: 5 MB.

Type of Household Member #2
MM slash DD slash YYYY
Max. file size: 5 MB.

Type of Household Member #3
MM slash DD slash YYYY
Max. file size: 5 MB.

Type of Household Member #4
MM slash DD slash YYYY
Max. file size: 5 MB.

Remember to include NAME, BIRTHDATE, AND PHOTO for EACH household member
  • Request to Transfer Membership Form
  • Member Household Change Request
  • Liability Waiver – Guest
  • Membership Declaration Form
  • Annual Election
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Nestled in the hills on the north shore of Lake Washington, our pool has been a fixture in the Uplake community of Kenmore since 1959.

18512 58th Ave NE, Kenmore, WA 98028

425-486-5758

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