Fillable LANCASTER GOLF CLUB, LLC 2022 Pool Pass Registration

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LANCASTER GOLF CLUB, LLC 2022 Pool Pass Registration

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LANCASTER GOLF CLUB, LLC
2022 Pool Pass Registration Form
______________________________ ____________________________
Print Last Name First Name
______________________________ ____________________________
Street Address City/State/Zip
______________________________ ____________________________
Phone Emergency Contact Name/Phone
Type (Please check)
Annual Pass Without Unlimited With Unlimited
Season Golf Pass Season Golf Pass
☐ Family * ☐ $500 ☐ $350
☐ Single ☐ $300 ☐ $150
Guest Fee: Guest must be pre-registered with pool management and all fees paid prior to
use. The guest fee is $10 per day per person.
* Family is defined as one or two adults and their dependent children (22 years of age or younger) all residing
at the same address. Childcare providers are not included on a family pass and are subject to the guest fee.
If more than one family resides in the same household, each family must purchase a separate Season Pass.
Family Information
Name Date of Birth
1. ________________________________ ___________________________
2. ________________________________ ___________________________
3. ________________________________ ___________________________
4. ________________________________ ___________________________
5. ________________________________ ___________________________
6. ________________________________ ___________________________
7. ________________________________ ___________________________
If eligible age-wise, as of June 1, then a dependent will be eligible for the remainder of the season.
Method of Payment
To complete registration, send Registration If you choose to pay by credit card,
Form together with payment payable to: provide the following:
Lancaster Golf Club, LLC Name of Cardholder: __________________
P.O. Box 266 Account #:__________________________
Lancaster, Ohio 43130 Type of Card: _______________________
Expiration Date: _____________________
CVC Code: _________________________
______________________________
Cardholder Signature / Date
In consideration of permission granted to me or my child or dependent or to my guest to engage in
recreational activities and reservations, I, the undersigned, on behalf of myself, my heirs, executors,
administrators, and assigns and on behalf of my household members, my children, dependents, childcare
providers and guests do hereby release, hold harmless, and discharge the Lancaster Golf Club, LLC, its
employees, agents, officers, assigns, and volunteers for any and all injuries suffered by myself, and on
behalf of my household members, my children, dependents, childcare providers and guests from any and
all claims, demands, actions, judgments, and executions, which they may bring related to damages or
injuries occurring on the Lancaster Golf Club’s premises.
I recognize and voluntarily accept on behalf of myself and on behalf of my children, dependents,
household occupants, my childcare providers, and guests, all of the potential risks and hazards associated
with participating in said recreational activities, no matter how remote or unlikely.
I hereby acknowledge that I have read and agree to comply with the terms and conditions of this
Agreement. I attest that I have read the rules of the Pool attached hereto and agree on behalf of myself, my
household occupants, my children, dependents, childcare providers and guests to abide by the rules and the
consequences of violations thereof.
Signature of Each Adult Family Member
Date: _____________ _____________________________________
Signature
Date: _____________ _____________________________________
Signature: (18 or over)
Date: _____________ _____________________________________
Signature: (18 or over)
Date: _____________ _____________________________________
Signature: (18 or over)
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LANCASTER GOLF CLUB, LLC 2022 Pool Pass Registration

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Completed 2 July 2022

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