Pool Registration Form

Fill in the information below:

Potomac Crossing Property Address:*

Home Telephone No.:*

Emergency Telephone No.:

Email Address:*

Member Application

Applicants ("Add Entry" for each applicant in the household)

First Name	Last Name	Relationship to Owner	Date of Birth (if under 18)	Allergic Reactions to Medications	New Pass or Renewal Sticker
						Edit Delete
There are no Entries.

Maximum number of entries reached.

Applicant Profile Images (Please upload in order of above list)

For each new applicant above include a photograph, uploaded in jpg, gif or png format. If no photograph is included, we will not be able to issue a pass for that family member. If you have a pass from last year, please indicate that on this application and we will provide a new sticker to be put on the back of your pool pass. No pass is needed for children age 2 and younger.

Applicant 1

Applicant 2

Applicant 3

Applicant 4

Applicant 5

Applicant 6

Additional Guest Passes

Please choose the number of book(s) of 5 guest passes at $10 per book (Check payable to Potomac Crossing Association – address provided below). Guest passes have no expiration date.

Number of book(s) of guest passes I would like at $10 per book

Check Number:

Submit Pool Application Request Form

Your submission will be received via email. For all other correspondence: Property Management People 552 Fort Evans Road, Suite 202 Leesburg, VA 20176 Fax: 703-771-9366 (Renewals Only) E-mail: pooladmin@pmpbiz.com PASSES ARE NOT MAILED, BUT WILL BE AVAILABLE FOR PICK-UP AT THE POOL.

Consent

I have reviewed and agreed to the Pool Rules & Regulations (click here to view)

Signature

Homeowner or Tenant Signature

Today's Date

Name

This field is for validation purposes and should be left unchanged.

Member Login

2020 Potomac Crossing Owners Pool Application