Deerfield Lake Resident Information
www.deerfieldlake.com
Date moved into Deerfield Lake
_____________________
First name(s)
_________________________________ Last name ______________________
Other adult residents
__________________________________________________________
Street address
________________________________________________________________
Phone number _____________________ Type
(home, cellular, business, etc) _____________
E-mail address
_______________________________________________________________
Husband’s employer ______________________
Wife’s employer ______________________
Children (information is used for pool passes
& pool management)
Name Birth date Name Birth
date
________________ ___________ ________________ ___________
________________ ___________ ________________ ___________
________________ ___________ ________________ ___________
Do you own the home? _______________
If not – Name, address and phone number of Owner
_________________________________
__________________________________________________________________________
__________________________________________________________________________
Would you be interested in helping with Deerfield Lake activities? _____________________
Please print this form, complete by hand and mail or deliver to…
Ruth Mather – Membership Chairwoman • 572-2594
Deerfield Lake Homeowner’s Association
17160 Penny Pines Circle
Strongsville OH 44136-7333
Or, modify this form
online, save as yourname.doc or yourname.html
and e-mail as an
attachment to mather@ruthmather.com