... above is correct and that I will abide by the pool rules and regulations. Sign: ... Office Only: Amount:______ Check
Edwardsville Glen Carbon Community Pool 2017 Season Membership If registering by mail please return this form with payment to Edwardsville Parks and Recreation, 118 Hillsboro Ave., PO Box 407, Edwardsville, IL 62025. Your pool pass can either be mailed to you or pick up at the Edwardsville Parks Office or at the pool. *No refunds will be made for any reason after opening day* We invite you to join the Edwardsville Glen Carbon Community Pool. All patrons must adhere to the following rules. Pool Pass: Pool Pass must be shown as you enter the pool area. Children: Children under 16 (as of current year Labor Day) are not permitted to stay without adult supervision Alcohol: No alcohol at any time. Smoking: No smoking or e-cigarettes on pool grounds. A complete list of pool rules will be available at the pool. Membership Types Family Membership (4 people) Additional family members $40 Single (must be 16 years or older) Senior Citizen (55 years old or older)
Beginning of the season $320 $175 $150
Name:_________________________________________________________________________ Address:_________________________________________________________________________ City, State and Zip_________________________________________________________________ Phone:____________________________________________ Email Address:__________________________________________________________________ Emergency Contact: Name:_______________________________________ Phone:______________________ Check Membership Type: ____Family ___Single
___Senior Citizen
_____Number of additional family members if applicable Name
Birthdate
Relationship
I hereby certify that the information given above is correct and that I will abide by the pool rules and regulations. Sign:_______________________________________________ Date:________________
