Woodlands Cabana Club 2023 Registration for Non-Swim Team Members

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An invoice will be issued to your email(s) following processing of your application. Payment should be made upon receipt to complete your registration. Payment can be made online by credit card or bank deposit using the link on your invoice. If paying by check please mail your payment to Woodlands Cabana Club, 111 Longleaf Dr., Walnut Creek, CA 94598, or drop it in the mailbox at the front of the club.

Full details of our fee structure can be found on our website at https://www.swimwoodlands.org/membership

Family Name *

Street Address *

City *

Zipcode *

Telephone (Home)

Telephone (Mobile) *

Email (Primary) *

Email (Alternative)

Type of membership you are applying for: *

Please select 1 option.

Family Membership (Any swim team household or household with 3+ members)

2 Person Household (Non-senior, non-swim team households with one or two adults)

Senior Membership (62+ years old. 2 adults per household maximum)

Do you wish to be included in the Woodlands Cabana Club and Swim Team Directory? *

Yes

Required

Please list names and dates of birth for all family members residing at the above address (if you need more space please include any further members in the additional information box below).

Member 1 - Name *

Member 1 - Date of Birth *

YYYY

Member 2 - Name

Member 2 - Date of Birth

YYYY

Member 3 - Name

Member 3 - Date of Birth

YYYY

Member 4 - Name

Member 4 - Date of Birth

YYYY

Member 5 - Name

Member 5 - Date of Birth

YYYY

Member 6 - Name

Member 6 - Date of Birth

YYYY

Emergency Information

Name of Health Insurer *

Health Provider - Telephone *

Emergency Contact - Name *

Emergency Contact - Telephone *

Additional Information - Please provide any additional information here.

Informed Consent and Waiver/Release

This section of the form must be signed by all adult members

In consideration of Woodlands Cabana Club’s (“WCC”) consent to the “Family” and its members, child(ren) and guests to participate in WCC swim lessons, Woodlands Swim Team, and/or to generally use the WCC pool and facility, including any social activities (“WCC Programs”), the undersigned parent(s) or guardian(s) of the above-named Family, on behalf of themselves, their children/family members and guests, acknowledge and understand the nature of the activities and the associated risks of participation in the WCC Programs and use of WCC pools and facilities. I/we hereby release, hold harmless, and forever discharge WCC and its members, officers and employees from any and all injuries and damages to the Family, its members, child(ren) and guests and/or their property in connection with their participation in WCC Programs or use of the WCC pool, and facilities, or going to or coming from WCC.

The undersigned also agree to indemnify, defend, and hold harmless, WCC and its members, officers, and employees from all claims, expenses, costs, attorney’s fees and losses arising from or connected with any injury or damage to person or property so long as such injury or damage arises from or is connected with acts or omissions of the Family, any of its members, and/or child(ren) and guests in connection with their participation in WCC Programs and/or their use of the WCC pool and facilities, excepting only such loss, damage, cost, expense, or liability that is caused by the sole negligence or willful misconduct of WCC and/or its members, officers, or employees.

Each adult member must agree to the terms of this agreement by checking the boxes and providing your name below. By entering your name(s) in the box below, you are effectively providing your signature, indicating that: *

All the information given on this form is true and accurate, to the best of my/our knowledge.

I/we have read this waiver/release and indemnity agreement, fully understand it's terms, understand that I/we have given up substantial rights by signing it, and have signed it freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my signature to be complete and unconditional release of all liability to the greatest extent allowed by law.

Required

Name (Member 1) *

Today's Date (Member 1) *

YYYY

Name (Member 2)

Today's Date (Member 2)

YYYY

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