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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:_____________________________________
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.
_____Please check here if you DO NOT want your child’s/children’s photos used on our GMP website.
Revised 05/01/2018