Waitlist Application

Complete this form and submit the non-refundable $50 application fee to apply for swim privileges at Merrimack Pool.

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Payment Status
Name*
First Last
Your account will be initiated under this family name.
# of Household Members*
Household members are immediate family living with you.
Address*
Street Address City State ZIP Code
Do You Live Within Merrimack Pool Boundaries?*
- Yes
- No
Please indicate whether you live within the boundaries of Goldsboro Rd (S), MacArthur Blvd (W), Wilson Lane (N) and River Road (E). Merrimack Pool gives preference to applicants who reside in neighborhoods surrounding the pool.
Phone*
Cell Phone
Email Address*
Password*
Enter Password Confirm Password

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How Did You Learn About Merrimack Pool?
We would like to say "thank you" for a referral or recommendation.
Waitlist Application Fee*
Price:
There is a one-time, non-refundable waitlist fee.
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
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