2021 Pool Passes

DO NOT CHANGE THIS DATE:

Date

Month Day Year

ONLY CHANGE IF NEEDED:

Pool Staff PW

Boro Staff PW

CHANGE THE FOLLOWING EVERY YEAR:

Year

Discount Date 1

Month Day Year

Discount Date 2

Month Day Year

Adult Price

Child Price

Senior Price

3 Family Price

4 Family Price

5 Family Price

6 Family Price

7 Family Price

8 Family Price

Money Collected By

Cash/Check Amt

Gross Payment

CC/PP Fees

Net Deposit

Pool passes are sold by the household with a maximum of 8 passes per household and cannot be shared by anyone. If you are purchasing pool passes for more than one household, please submit a separate registration form for each household. If you purchase pool passes for more than one household under one registration, all pool passes for that registration will be suspended for the rest of the year and all members will be subject to the daily rate to access the pool.

Pool Pass Pricing

PASS TYPE	PRICE
Adult	$80
Child (Age 4 to 13)	$70
Senior (Age 65+)	$70
Family of THREE	$180
Family of FOUR	$210
Family of FIVE	$240
Family of SIX	$270
Family of SEVEN	$300
Family of EIGHT	$330

50% Discount

Effective August 1st

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Payment Method *

Cash/Check PayPal/Credit Card

STOP

unless you are at the

POOL or BOROUGH OFFICE

to complete the rest of this form.

# of Adult Passes

# of Child Passes (Age 4 to 13)

# of Senior Passes (Age 65+)

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Total # of Passes

Total Due (Hidden)

Total Due

The maximum number of passes per household is 8.

Please enter up to 8 passes.

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Name on Pass - 1 *

First Name Last Name

Age - 1 *

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Name on Pass - 2 *

First Name Last Name

Age - 2 *

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Name on Pass - 3 *

First Name Last Name

Age - 3 *

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Name on Pass - 4 *

First Name Last Name

Age - 4 *

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Name on Pass - 5 *

First Name Last Name

Age - 5 *

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Name on Pass - 6 *

First Name Last Name

Age - 6 *

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Name on Pass - 7 *

First Name Last Name

Age - 7 *

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Name on Pass - 8 *

First Name Last Name

Age - 8 *

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Household Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

E-mail *

Pool passes are sent by email. If you do not have a printer to print your pool pass, you will have to request a copy of your pool pass at the pool on your first visit.

PayPal/Credit Card *

USD Town Park Pool Pass(es)

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STOP HERE

You must pay the attendant to complete your purchase.

Checks should be made payable to "Canonsburg Borough".

Staff Use Only *

Must Collect

If you have any questions, please email us at townpark@canonsburgboro.com.

Town Park Pool Pass Registration