Applicant Name *

First Name

Last Name

Phone *

(###)

###

####

Co-Applicant Name

First Name

Last Name

Co-Applicant Phone

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Lifetime Membership Dues *

$0 (I have already paid this)

$1,000 (I'm new to the neighborhood/pool paying by check)

$1,020 (('m new to the neighborhood/pool paying by venmo)

Voucher (receive from your builder/realtor - must be emailed to kilkennypool@gmail.com)

Annual Dues *

$475 Family Membership (paying by check)

$485 Family Membership (paying by venmo)

$375 Couples Membership (paying by check)

$385 Couples Membership (paying by venmo)

$225 Single Membership (paying by check)

$235 (Single Membership (paying by venmo)

Babysitters (Limit 2) *

Grandparents count as 1 babysitter.

$0 (No Babysitters)

$25 (1 Babysitter)

$30 (2 Babysitters)

How will you pay your fees?

VENMO: @Kilkennypool - MUST INCLUDE NAME AND ADDRESS IN NOTE FIELD

CHECK: Check made out to Kilkenny Farms Pool; Mailed or dropped off to 1008 Limerick Lane, Waunakee

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT *

In consideration of participating in the sport of swimming, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence Kilkenny Farms Neighborhood Pool and its owners, directors, officers, employees, agents, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as "Releasees"), on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows: 1. I acknowledge that the sport of swimming involves known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, death as a result of drowning or brain damage caused by near drowning; broken bones, torn ligaments or strains as a result of falls on the deck or from a diving board; medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply cannot be eliminated despite the use of safety equipment, without jeopardizing the essential qualities of the activity. 2. I expressly accept and assume all of the risks inherent in this activity or that might have been caused by the negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation. 3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from any and all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in the activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume and bear the costs of all risks that may be created, directly or indirectly, by any such condition. 5. In the event that I file a lawsuit, I agree to do so solely in the state where Releasees' facility is located, and I further agree that the substantive law of that state shall apply. 6. I agree that if any portion of the agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect. By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence. I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain.

I accept the Terms and Conditions

COVID-19 Liability Release *

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my family, including child(ren), and I may be exposed to or infected by COVID-19 while on site at the pool and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the pool may result from the actions, omissions, or negligence of myself and others, including, but not limited to, the Pool Board and pool employees, volunteers, and program participants and their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I, my family and my child(ren) may experience or incur in connection with my child(ren)’s attendance at the pool or participation in pool activities (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless the Pool Board and the pool management company and their employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Pool Board and the pool management company and their employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in pool facility activities.

I accept the Terms and Conditions

Electronic Signature *

By signing this application, you are confirming that you have read, understand, and are willing to enforce the pool rules in order to maintain a safe and clean environment at the pool. Non-compliance with the pool rules and/or direction given by the Pool Board or other Pool Staff may result in suspension of membership.

First Name

Last Name