FOR AND IN CONSIDERATION of the use of and/or membership in the Polk Place Community Pool, the undersigned hereby acknowledge and agree as follows:
- That I/we have read the Rules and Regulations governing the use of the Polk Place Community Pool and hereby agree to abide by those Rules and Regulations, including any amendments thereof.
- That I/we understand that THERE WILL BE NO LIFEGUARD AT THE POOL AT ANY TIME and that it shall be my/our responsibility to insure my/our own safety and that if my/our children and guests.
- That I/we, for myself/ourselves, my/our heirs, executors and successors in interest, do hereby release, acquit and forever discharge the Polk Place Homeowners Association, the individual owners/members of the Polk Place Homeowners Association, its officers, directors, shareholders, principals, agents, representatives, employees and successors in interest, from any and all claims, damages, costs and/or loss of services for bodily injury or property damage arising out of my/our use of the Polk Place Community Pool, clubhouse, or other related pool facilities.
- That to the extent allowed by law, I/we further agree to indemnify and hold harmless the Polk Place Homeowners Association, the individual owners/members of the Polk Place Homeowners Association, its officers, directors, shareholders, agents, principals, representatives, employees and successors in interest from any and all claims, damages, costs and/or loss of services for bodily injury or property damage arising out of my/our children’s use of the Polk Place Community Pool, clubhouse or other related pool facility.
- That the releases and indemnities set forth herein shall be binding upon me/us regardless of whether the injury, accident, or event giving rise to a loss/claim is the result of my/our negligence, or the result of negligence on the part of the Polk Place Homeowners Association, the individual owners/members of the Polk Place Homeowners Association, its officers, directors, shareholders, principals, agents, representatives, employees and/or successors in interest.
Executed this _______________ day of ___________________ 2010 |
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Names of Family Members Using Pool: |
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Address |
Phone Number |
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_________________________________ |
e-mail |
card key no.(s) |
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rev. 5/13/2010
Word Document of this form
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