Stonemont Pool
MEMBERSHIP and EMERGENCY INFORMATION SHEET

SUMMER 2024

ALL MEMBERS: This form must be completed and on file at the pool before any member of your household will receive their passes and thus are able to swim.  The form data will be kept on a emergency use sheet near the clubhouse telephone.  In case of an accident call 911.  Anyone swimming when a lifeguard is not on duty is swimming at his/her own risk.

This information will be used to create membership ID badges that must be displayed at all times while members are at the pool.
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 I, as a member in good standing with Stonemont Pool & Racquet Club (hereinafter referred to as 'SP&RC'), waive any and all liability and hold harmless the membership and the Board of Directors of SP&RC due to accident, illness, injury, fatality, or Act of God while I, any member of my family, guest, or other person otherwise associated with my membership, participate in Swim At Your Own Risk (SAYOR).    *
PARENT NAME(S) (If there are NO MINORS listed on the household membership, list ADULT NAMES on membership) *
ADDRESS *
HOME PHONE
WORK PHONE
MOBILE PHONE
EMAIL ADDRESS *
PLEASE LIST ALL CHILDREN LIVING AT HOME (NAME, SEX, DOB, & SWIMMING ABILITY)
Please describe any medical problems or allergies of any household members:
IN CASE OF ACCIDENT; if neither parent/caregiver can be reached, CONTACT:
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