Pool Pass Registration

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Town of Liberty Parks & Recreation Department Pass Guidelines:

1) Person must be in possession of pass to be allowed Liberty Resident privileges at all P&R programs and facilities.
2) Sharing or otherwise lending passes will result in forfeiture of privileges.
3) All passes are valid for time period shown.
4) Pass holder agrees to abide by all rules and regulations governing P&R facilities, programs and park areas. Failure to do so may result in the loss of privileges.
5) This card must be presented for registration to any program or activity and may be required during the course of the program at the discretion of supervisor or instructor.
6) Family passes apply to only those members of the nuclear family that reside within the same residence. This does not include the extended family of grandparents, cousins, aunts, uncles or other relatives even though they may live in the same household.
7) Lost or stolen cards can be replaced for a charge of $4.00 at the P&R office.

When submitting this form, you are certifying that you have read the Registration & Refund Policy.

Email *

Family (Last) Name *

Mailing Address *

City, State, Zip *

Please mark whether you are a resident or non-resident. *

Resident

Non-Resident

Full Name and Date of Birth (First Person) *

Full Name and Date of Birth (Second Person)

Full Name and Date of Birth (Third Person)

Full Name and Date of Birth (Fourth Person)

Full Name and Date of Birth (Fifth Person)

Full Name and Date of Birth (Sixth Person)

Fees *

Senior Citizen Pass (Resident: $30 | Non-Resident $40)

Individual Pass (Resident: $35.00 | Non-Resident $45)

Family 3 Pass (Resident: $60 | Non-Resident $70)

Family 4 Pass (Resident $85 | Non-Resident $95) * Each additional family members is $15 each

Payment

Please mail in a check made out to Town of Liberty Parks and Recreation at 119 North Main Street, Liberty, NY 12754.
Application will not be finalized until a payment is received.

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