Holiday Swim Club
Membership & Emergency Contact Form
Name (s) *
Spouse Name
Cell Phone Number (s) *
Daytime/Work Phone Number (s) *
Email *
Children's Name and Age *
Address *

Please list or explain any medical or allergy information


 *
Emergency Contacts

Name and Phone Number
Name and Phone Number
 *
Physician Name and Phone Number
 *

I (we) have reviewed the ​Rules and Regulations​ for Holiday Pool Inc., (DBA ​Holiday Swim Club) available at holidayswimclub.org ​and agree to abide by them as they are administered by the Executive Team and/or the Board of Directors. 

I (we) understand that lifeguards ​are not​ on duty at all times.

I (we) authorize ​Holiday Pool Inc., (DBA Holiday Swim Club), ​it’s Board of Directors, Executive Team, Employees and Members to secure the services of a physician or hospital, and to incur expenses for necessary services in the event of accident, injury or illness. I (we) agree to provide payment for such expenses without protest. Every reasonable effort will be made to contact me (us), the parent/guardian(s), as soon as possible.

I (we) hereby release Holiday Pool Inc., (DBA Holiday Swim Club), the Board of Directors, Executive Team, Employees, Members and any persons associated, from any and all loss or damages resulting therefrom on account of injury while present. 

I (we) agree that this release and waiver is intended to be as broad and inclusive as permitted by the State of Oregon, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

***Type Name Below for Acknowledgment***

 *

Family memberships include two parents and all non-married children 23 years of age or younger living at the same address. Grandparents, nannies or caretakers can accompany children under the age of 14.

***Type Name Below for Acknowledgment***

 *

I (we) understand that my membership at ​Holiday Pool Inc., (DBA Holiday Swim Club) must be paid in full by May 1, 2023.

I (we) understand that no part of my membership payment will be refunded for any reason.

I (we) understand and promise to abide by the rules and regulations as developed by the ​Holiday Pool Inc., (DBA Holiday Swim Club).

I (we) understand that I am responsible for all guests that I bring to ​Holiday Pool Inc., (DBA Holiday Swim Club).

***Type Name Below for Acknowledgment***

Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms