2015 Pool Pass (Oak Ridge North Otters)

Oak Ridge North Pool

2015 Pool Pass (Oak Ridge North Otters)

Oak Ridge North Resident ($25): ____ Non-Resident ($75): _____

YMCA Facility (pays monthly membership dues to the South Montgomery County YMCA) member (no fee):

____ Oak Ridge North Resident ___ Non-resident

Full Name: ______Date Of Birth: ______

Spouse: ______Date Of Birth: ______

Address: ______City: ______Zip: ______

Phone number: (h): ______(w): ______(c): ______

Emergency Contact: ______Emergency Phone: ______

Children:

* Please note that kids under the age of 6 MUST have a parent/guardian in the pool within arms length at all times!!

*Participants 12 years and younger, and those who can not swim, must have an adult 16 years or older on the pool deck at all times.

Full Name: ______Date Of Birth: ______Gender: ______

Full Name: ______Date Of Birth: ______Gender: ______

Full Name: ______Date Of Birth: ______Gender: ______

Full Name: ______Date Of Birth: ______Gender: ______

Full Name: ______Date Of Birth: ______Gender: ______

·  Only Family members listed may be admitted under this pool pass. Misuse of this pass may be cause for dismissal of membership.

·  I understand and have a copy of the pool rules for the Oak Ridge North City Pool. Failure to comply with these rules may result in expulsion from the pool.

·  I agree to indemnify, hold harmless, assume liability for and defend the YMCA of Greater Houston, its affiliates, agents, servants, employees, volunteers, officers and directors, from and against all demands, assertions of liability, actual damages, claims or actions whatsoever which arise or are alleged to have arisen from my participation, or participation of any family member listed, in YMCA activities or while on YMCA premises to include any acts or omissions on my part.

Signature______Date______

For office use:

Date: ______Amount paid: ______Receipt Number: ______

Cash Check CC Staff initials: ______Membership Number: ______

South Montgomery County YMCA

6145 Shadowbend Place, The Woodlands, Texas 77381

P 281.367.9622 F 281.367.3659 ymcahouston.org/south-montgomery-county/

YMCA Mission: To put Judeo Christian principles into practice through programs that build healthy

spirit, mind and body for all. Everyone is welcome.