addition of non-family member to membership - Bellevue Club

ADDITION OF NON-FAMILY MEMBER TO MEMBERSHIP
Member Name
Membership Number
o NON-RESIDING Nanny (Not residing full time in the residence of member)
Name of Nanny
Date of Birth
I understand that the nanny may use the card only when taking the children under my membership
to the Club and may accompany them into the swimming pool and dining areas while caring
for them. The nanny may use the nanny card to pay for programs for the children and for food
service when accompanying them at the Club. The nanny is restricted from using other areas of
the Club and does not have guest privileges.
The nanny card must be returned to the Club when the nanny is no longer caring for the children.
No additional dues required.
o RESIDING Nanny (Residing full time in the residence of member)
Name of Nanny
Date of Birth
1099 tax form declaring nanny is an employee.
Nanny receives a regular membership card and has membership privileges.
Member is responsible for nanny’s charges.
Nanny’s membership card must be returned to the Club when the nanny is no longer caring for
the children.
$150.00 fee to add nanny, plus intermediate non-student monthly dues.
Member Name (PRINT)
Member Signature
Date
APPROVED BY (Bellevue Club)
Date
See reverse side
11200 SE 6th Street Bellevue, Washington 98004 Telephone 425.455.1616 FAX 425.688.3187

o Foster Child (Must be under 18 years of age and residing with member)
Name of Foster Child
Date of Birth
Documentation is required to prove the child has been legally placed in home of member. At 18
years of age, membership privileges cease and membership card must be returned to the Club.
No additional dues required.
o Exchange Student (Must be under 18 years of age and residing with member)
Name of Exchange Student
Date of Birth
Must provide proof of status.
At age 18 the exchange student will be removed from the membership unless
otherwise approved by Club.
No additional dues required unless exchange student is 18 years of age or older.
o Disabled Dependent Child (Age 19 and older and residing with the member)
Name of Disabled Child
Date of Birth
Same monthly dues as for Intermediate Student.
o Elderly Dependent Parent (Age 65 and older and residing with the member)
Name of Parent
Date of Birth
Member must provide 1099 tax return for prior year showing parent as a dependent.
$150 fee to add to membership, plus intermediate non-student monthly dues.
TO ADD ANY OTHER INDIVIDUAL RESIDING IN THE MEMBER’S HOME, ASK FOR OUR
PETITION TO ADD A QUALIFIED PERSON TO A FAMILY MEMBERSHIP.
Member Name (PRINT)
Member Signature
Date
APPROVED BY (Bellevue Club)
Date
11200 SE 6th Street Bellevue, Washington 98004 Telephone 425.455.1616 FAX 425.688.3187