Member Information & Waiver Spam protection, skip this field Thank you for joining or renewing! Please fill out this form, and then you will be directed to the payment page. I am a: New Member joining for the first time Renewing Member My membership information has changed since last year not changed since last year Member Information Member Name(s) Children, include age(s) Address City State Postal Code Blacklake Resident Yes No Primary Phone Number Alternate Phone Number (optional) Email Address Blacklake Swim Club uses email to communicate announcements, annual events and other information to its members. This is our main method of communication with you so please provide an e-mail address you check regularly. BLSC uses your information to operate and manage the club and DOES NOT sell or provide it to any others. Please tell us how you heard about Blacklake Swim Club Another BLSC Member Resident of Blacklake Friend Website Flyer or Banner Other If Other, please describe (optional) Key Fob Agreement I understand that membership is for people listed on this form who live in the same household, and that my key fob is not to be shared with others. Pool Rules & Regulations Please read the Blacklake Swim Club Rules & Regulations. All members are expected to know and abide by the rules in order to keep a clean, safe and pleasant space. Rules & Regs Acknowledgement: I have read, understand and agree to follow the Blacklake Swim Club Rules & Regulations. Guest Policy Please read the Guest Policy. Guest Policy Acknowledgement: I have read the Guest Policy. I acknowledge and agree that I am responsible for my guests. Waiver Voluntary Participation: (optional) I acknowledge that I have voluntarily applied to participate in swimming and/or any other authorized activity of the private pool facility at the premises of the Blacklake Swim Club, located in the Blacklake Village. Assumption of Risk: (optional) I am aware that swimming, exercising and use of the pool facility is a hazardous activity. I am voluntarily participating in these activities with the knowledge of the danger involved, and hereby agree to accept any and all risks of injury or death and verify this statement by accepting the terms and conditions below. Waiver/Exculpatory Release: (optional) As consideration for being permitted by Blacklake Swim Club, or one of its affiliated organizations to participate in these activities and use their facilities, I hereby agree that I, my assignees, heirs, distributes, guardians and legal representatives waive the right to make a claim against, sue or attach the property of Blacklake Swim Club or any of its affiliated organizations for injury or damage resulting from the negligence or other acts, howsoever caused, by any employee, agent or contractor of Blacklake Swim Club or any of its affiliated organizations as a result of my participation in swimming and/or any other authorized activity of the private pool facility. I hereby release Blacklake Swim Club and any of its affiliated organizations from all actions, claims or demands that I, my assignees, heirs, distributes, guardians and legal representatives now have or may hereafter have for injury or damage resulting from my use of the private pool facility in Blacklake Village. Knowing and Voluntary Execution: (optional) I have carefully read this agreement and fully understand its contents. I am aware that this is a Waiver, Release of Liability and a Contract between myself and Blacklake Swim Club and/or its affiliated Organizations and sign it of my own free will and accord. Executed In (optional) Executed On (optional) City State Date Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 Yes I agree to the terms and conditions Signature I agree that my typed name below will be as valid as a handwritten signature to the extent allowed by local law Releaser (optional)