Brochure Spring 2019 - Page 47

2019 ROOSEVELT AND FLICK OUTDOOR POOL MEMBERSHIP APPLICATION Glenview Park District outdoor pool memberships are photo I.D. cards that are renewable from season to season. Anyone who already has a Photo I.D. card for Splash Landings, Park Center Health and Fitness or an outdoor pool membership card need only bring in that I.D. along with this membership application and the appropriate fees. It will not be necessary to have a new photo taken. Photos need not be taken at the time application is submitted. Photos may be taken at Park Center during regular business hours. Proof of residency (house purchase contract or apartment lease, current utility bill, real estate tax bill, or homeowners or rental insurance policy) is required for new residents and nonresidents whose information is not currently in our registration system. Complete the application below listing the name of each person to receive a membership card. Children under 2 years by June 1 are admitted to the pools free and do not require a membership. Glenview Park District summer camp programs do not include a pool membership in the camp fee. The cost to replace an outdoor pool membership card is $10. A 10% cancellation charge per membership will be assessed on all membership refunds requested prior to the opening of pool season with a minimum fee of $5 and a maximum fee of $15 assessed (per membership). There will be no membership refunds after the pool season has begun, except in the case of injury or medical condition (proof required); on such refunds, the amount of the refund will be prorated and the service fee will be assessed. Household Name ______________________________________________________ Household #______________________________________ Address____________________________________________ City_____________________________ State___________ Zip ________________ Phone_________________________________________ Email__________________________________________________________________ All memberships are issued to family members who reside at the same residence. Please check the box beside the membership type that is needed and its applicable fee. Name (list each individually) Birthday (mm/dd/yy) Individual __________________ ________ Add’l Family ________________ ________ Add’l Family ________________ ________ Add’l Family ________________ ________ Add’l Family ________________ ________ Senior or Nanny _____________ ________ 5 Punch Guest Pass (valid for the 2019 outdoor pool season only) 10 Punch Guest Pass (valid for the 2019 outdoor pool season only) New or Renewal N N N N N N R R R R R R ☐ GET-IT Pass Amount to Deposit (up to $400) $_______________ Resident Nonresident Early Bird 3/1-5/15 ☐ $96 ☐ $63 ☐ $63 ☐ $63 ☐ $63 ☐ $85 Resident Beginning 5/16 ☐ $112 ☐ $78 ☐ $78 ☐ $78 ☐ $78 ☐ $101 Early Bird 3/1-5/15 ☐ $121 ☐ $79 ☐ $79 ☐ $79 ☐ $79 ☐ $126 Nonresident Beginning 5/16 ☐ $140 ☐ $95 ☐ $95 ☐ $95 ☐ $95 ☐ $140 ☐ $46 ☐ $46 N/A N/A ☐ $92 ☐ $92 N/A N/A GET-IT Pass and Pool Fees Total Amount Due $________________ GET-IT Pass balances are available to all current outdoor pool membership I.D. card holders within the same household. All Guest Cards purchased under the same household will have access to the money on deposit in the GET-IT Pass account. GET-IT Pass balances are non-transferable. The balance at the end of the season will be refunded by 10/5/19. No refunds will be issued for any balance of $5 or less. The Glenview Park District is not responsible for lost, stolen or misused Pool Membership I.D. cards, with or without GET-IT Pass account balances. Method of Payment ☐ Cash ☐ Check ☐ MasterCard ☐ Visa ☐ Discover Card Credit Card No. __________________________________________ Exp. Date ____________________ Amount of Charge __________________ Signature _______________________________________________ Date _______________________ Waiver and Release of all Claims and Assumption of Risk Please read this form carefully and be aware that in signing up and participating in this program/activity, you will be expressly assuming the risk and legal li- ability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program/activity. I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waive and relinquish all claims I or my minor child/ward may have (or accrue to me or my child/ ward) as a result of participation in this program/activity against the Glenview Park District, including its officials, agents, volunteers and employees (hereinafter collectively referred to as “Glenview Park District”). I do hereby fully release and forever discharge the Glenview Park District from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward and arising out of, connected with, or in any way associated with this program/activity. I understand that photos and videos are periodically taken of people participating in Glenview Park District programs and activities and I agree that any photograph or videotape taken by the park district of me or my minor child/ward while participating in a park district program or activity may be used by the park district for promotional purposes including its electronic media, videotapes, brochures, flyers and other publications without additional prior notice, permission or compensation to the participant. I understand that memberships may only be used by individuals to whom they are issued and misuse is cause for confiscation of the membership. I have read and understand the membership refund policy and waiver above. Signed by the adult making the application _______________________________________________________________________________________________ Do you need any accommodations, in accordance with the Americans with Disabilities Act? ____ Yes ____ No Mail or drop off this application to Park Center, 2400 Chestnut Ave., Glenview, IL 60026 or fax to 847-657-6231. Memberships may also be renewed or purchased online at 43