2022 Pool Pass Application

Pool Pass Application

The pool season is almost here!

The Manchester Farm community pool is available for use by all owners and residents of Manchester Farm Community Association and Destiny Road Homeowners Association.

A limited number of outside memberships may also be purchased on a first come, first served basis.

To apply for membership, please complete the following application online or fill out and return the application that can be downloaded at www.ManchesterFarm.com .

Individuals without a valid pool pass for the 2022 season will not be allowed into the pool. Only those people listed on the attached application will be authorized to use the pool this year. Individuals not listed on this application may use the pool as a Guest.

Please feel free to contact the Manchester Farm on site office at (301) 515-9100 or Info@ManchesterFarm.com should you have any questions about the application process.
Your information will be automatically saved every 30 seconds, for up to 2 days. You can stop filling out this form at any time and complete it within 2 days by using the same link on the same device using the same browser.

Please note that this form works best using Google Chrome, Mozilla Firefox or Safari. We recommend that you use one of these browsers to complete this form.
Before you begin your online submission, be sure to have the following information:

1. The name and birthdate of all Pool Members. A membership is required for anyone who is 3 years of age or older as of the date of pool opening.

2. A photo must be on file for all Pool Members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB with a photo-image name (including extension) not longer than 32-characters.

3. Your credit card information should you wish to purchase an outside pool membership, replacement pass or extra guest passes. Visa, Mastercard, American Express, and Discover are accepted.
First Name *
Middle Name
Last Name *
Suffix
APPLICANT TYPE *

Owner-Occupant Landlord Tenant Outside Pool Member
Renters must have a current lease addendum on file with the Manchester Farm office. You can download one here .
Number on back of pool pass

MANCHESTER FARM OR DESTINY ROAD ADDRESS (Required for Owner-Occupants, Landlords, and Tenants)
Street *
House-No. *
Unit-No. *
Outside Address (Required for Landlords and Outside Pool Members)
Street Address *
City *
State *
ZipCode *

COMMUNICATIONS (Primary Phone and E-mail Address are Required; Work Phone is recommended)
Primary Phone *
Work Phone
E-mail Address *

PURCHASE - Outside Pool Membership -
Note: There is a limit of 1 Membership per Application. _______________________________________ Outside memberships may be purchased by the residents outside of Manchester Farm: Up to 2 people: $200 (Note, one person must be 18 years of age or older) 3-5 people: $400 (Note, one person must be 18 years of age or older) 6+ people: $50 (Note, one person must be 18 years of age or older) An Outside Membership does not need to be purchased for anyonewho is under 3 years of age as of September 4, 2019. Passes are offered on a first-come, first-served basis and only a limited number of memberships are available._______________________________________
Please confirm below that you wish to Purchase an Outside Pool Membership:
Purchase Outside Pool Membership *

Yes
Do you want to add a person(s) to your existing Membership *

Yes No
PURCHASE - Additional Guest Passes
Each Household will receive 1 free Guest Pass good for 10 visits. Additional Guest Passes may be purchased for $30 each.
Purchase Additional Guest Passes ($50 fee per Pass) *

Yes No
Quantity of additional Guest Passes *
Replace lost or stolen Passes ($10 fee per Pass) *

Yes No
Quantity of Replacement Passes *
Replace lost or stolen Permanent Guest Pass ($10 fee). *

Yes No
Quantity of Replacement Permanent Guest Passes *
Old TOTAL TO BE BILLED
Includes all varieties of Passes that you selected on this Form.
NAMES OF PERSONS NEEDING POOL PASSES (INCLUDING APPLICANT LISTED ABOVE)
Person #1 Information - HEAD OF HOUSEHOLD
Age-Category – Based on age as of May 28, 2022. Birthdate – Required for all Pool Members. Allow – Children between the ages of 12-15 may use the pool without an Adult provided that the “YES” box is checked below. If this box is not checked, that child will not be permitted into the pool unless with an Adult 16 years of age or older.

This individual must be the head of the household (either a homeowner or lease signer) or an Adult who is 16 years of age or older.
Person #1 First-Name *
Person #1 Middle-Name
Person #1 Last-Name *
Person #1 Gender *
Person #1 Age-Category *
Must be an Adult Head of Household

Person #1 Adult (16 and Over)
Person #1 Birthdate Adult 16 & Over *

Month Day Year
Person #1 Permissions (Child 12-15)
Person #1 Birthdate Child 12-15 *

Month Day Year
Person #1 Allow *
By selecting "YES" you are giving permission for this Child to enter the pool facility without an accompanying Adult.
By checking the appropriate box below and submitting this form, you represent that you are the parent/legal guardian of the child(ren) listed above and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
Please confirm that you are granting this permission for the Child listed as Person #1 *

Yes
Person #1 Permissions (Child under 12)
Person #1 Birthdate Child under 12 *

Month Day Year
The Child listed as Person #1 is under the age of 12 and must ALWAYS be accompanied by an Adult.
Please confirm that you acknowledge this stipulation for the Child listed as Person #1 *

Yes.
Person #1 Photo -
A photo must be on file for all pool members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB. Members will not be admitted to the pool without a photo on file .
Person #1 Photo Attachment *
Add Person 2?

Yes

Person #2 Information
Age-Category – Based on age as of May 28, 2022. Birthdate – Required for all Pool Members. Allow – Children between the ages of 12-15 may use the pool without an Adult provided that the “YES” box is checked below. If this box is not checked, that child will not be permitted into the pool unless with an Adult 16 years of age or older.
Person #2 First-Name *
Person #2 Middle-Name
Person #2 Last-Name *
Person #2 Gender *
Person #2 Age-Category *

Person #2 Adult (16 and Over)
Person #2 Birthdate Adult 16 & Over *

Month Day Year
Person #2 Permissions (Child 12-15)
Person #2 Birthdate Child 12-15 *

Month Day Year
Person #2 Allow *
By selecting "YES" you are giving permission for this Child to enter the pool facility without an accompanying Adult.
By checking the appropriate box below and submitting this form, you represent that you are the parent/legal guardian of the child(ren) listed above and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
Please confirm that you are granting this permission for the Child listed as Person #2 *

Yes
Person #2 Permissions (Child under 12)
Person #2 Birthdate Child under 12 *

Month Day Year
The Child listed as Person #1 is under the age of 12 and must ALWAYS be accompanied by an Adult.
Please confirm that you acknowledge this stipulation for the Child listed as Person #2 *

Yes.
Person #2 Photo -
A photo must be on file for all pool members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB. Members will not be admitted to the pool without a photo on file .
Person #2 Photo Attachment *
Add Person 3?

Yes

Person #3 Information
Age-Category – Based on age as of May 28, 2022. Birthdate – Required for all Pool Members. Allow – Children between the ages of 12-15 may use the pool without an Adult provided that the “YES” box is checked below. If this box is not checked, that child will not be permitted into the pool unless with an Adult 16 years of age or older.
Person #3 First-Name *
Person #3 Middle-Name
Person #3 Last-Name *
Person #3 Gender *
Person #3 Age-Category *

Person #3 Adult (16 and Over)
Person #3 Birthdate Adult 16 & Over *

Month Day Year
Person #3 Permissions (Child 12-15)
Person #3 Birthdate Child 12-15 *

Month Day Year
Person #3 Allow *
By selecting "YES" you are giving permission for this Child to enter the pool facility without an accompanying Adult.
By checking the appropriate box below and submitting this form, you represent that you are the parent/legal guardian of the child(ren) listed above and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
Please confirm that you are granting this permission for the Child listed as Person #3 *

Yes
Person #3 Permissions (Child under 12)
Person #3 Birthdate Child under 12 *

Month Day Year
The Child listed as Person #1 is under the age of 12 and must ALWAYS be accompanied by an Adult.
Please confirm that you acknowledge this stipulation for the Child listed as Person #3 *

Yes.
Person #3 Photo -
A photo must be on file for all pool members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB. Members will not be admitted to the pool without a photo on file .
Person #3 Photo Attachment *
Add Person 4?

Yes

Person #4 Information
Age-Category – Based on age as of May 28, 2022. Birthdate – Required for all Pool Members. Allow – Children between the ages of 12-15 may use the pool without an Adult provided that the “YES” box is checked below. If this box is not checked, that child will not be permitted into the pool unless with an Adult 16 years of age or older.
Person #4 First-Name *
Person #4 Middle-Name
Person #4 Last-Name *
Person #4 Gender *
Person #4 Age-Category *

Person #4 Adult (16 and Over)
Person #4 Birthdate Adult 16 & Over *

Month Day Year
Person #4 Permissions (Child 12-15)
Person #4 Birthdate Child 12-15 *

Month Day Year
Person #4 Allow *
By selecting "YES" you are giving permission for this Child to enter the pool facility without an accompanying Adult.
By checking the appropriate box below and submitting this form, you represent that you are the parent/legal guardian of the child(ren) listed above and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
Please confirm that you are granting this permission for the Child listed as Person #4 *

Yes
Person #4 Permissions (Child under 12)
Person #4 Birthdate Child under 12 *

Month Day Year
The Child listed as Person #1 is under the age of 12 and must ALWAYS be accompanied by an Adult.
Please confirm that you acknowledge this stipulation for the Child listed as Person #4 *

Yes.
Person #4 Photo -
A photo must be on file for all pool members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB. Members will not be admitted to the pool without a photo on file .
Person #4 Photo Attachment *
Add Person 5?

Yes

Person #5 Information
Age-Category – Based on age as of May 28, 2022. Birthdate – Required for all Pool Members. Allow – Children between the ages of 12-15 may use the pool without an Adult provided that the “YES” box is checked below. If this box is not checked, that child will not be permitted into the pool unless with an Adult 16 years of age or older.
Person #5 First-Name *
Person #5 Middle-Name
Person #5 Last-Name *
Person #5 Gender *
Person #5 Age-Category *

Person #5 Adult (16 and Over)
Person #5 Birthdate Adult 16 & Over *

Month Day Year
Person #5 Permissions (Child 12-15)
Person #5 Birthdate Child 12-15 *

Month Day Year
Person #5 Allow *
By selecting "YES" you are giving permission for this Child to enter the pool facility without an accompanying Adult.
By checking the appropriate box below and submitting this form, you represent that you are the parent/legal guardian of the child(ren) listed above and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
Please confirm that you are granting this permission for the Child listed as Person #5 *

Yes
Person #5 Permissions (Child under 12)
Person #5 Birthdate Child under 12 *

Month Day Year
The Child listed as Person #1 is under the age of 12 and must ALWAYS be accompanied by an Adult.
Please confirm that you acknowledge this stipulation for the Child listed as Person #5 *

Yes.
Person #5 Photo -
A photo must be on file for all pool members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB. Members will not be admitted to the pool without a photo on file .
Person #5 Photo Attachment *
Add Person 6?

Yes

Person #6 Information
Age-Category – Based on age as of May 28, 2022. Birthdate – Required for all Pool Members. Allow – Children between the ages of 12-15 may use the pool without an Adult provided that the “YES” box is checked below. If this box is not checked, that child will not be permitted into the pool unless with an Adult 16 years of age or older.
Person #6 First-Name *
Person #6 Middle-Name
Person #6 Last-Name *
Person #6 Gender *
Person #6 Age-Category *

Person #6 Adult (16 and Over)
Person #6 Birthdate Adult 16 & Over *

Month Day Year
Person #6 Permissions (Child 12-15)
Person #6 Birthdate Child 12-15 *

Month Day Year
Person #6 Allow *
By selecting "YES" you are giving permission for this Child to enter the pool facility without an accompanying Adult.
By checking the appropriate box below and submitting this form, you represent that you are the parent/legal guardian of the child(ren) listed above and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
Please confirm that you are granting this permission for the Child listed as Person #6 *

Yes
Person #6 Permissions (Child under 12)
Person #6 Birthdate Child under 12 *

Month Day Year
The Child listed as Person #1 is under the age of 12 and must ALWAYS be accompanied by an Adult.
Please confirm that you acknowledge this stipulation for the Child listed as Person #6 *

Yes.
Person #6 Photo -
A photo must be on file for all pool members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB. Members will not be admitted to the pool without a photo on file .
Person #6 Photo Attachment *
Add Person 7?

Yes

Person #7 Information
Age-Category – Based on age as of May 28, 2022. Birthdate – Required for all Pool Members. Allow – Children between the ages of 12-15 may use the pool without an Adult provided that the “YES” box is checked below. If this box is not checked, that child will not be permitted into the pool unless with an Adult 16 years of age or older.
Person #7 First-Name *
Person #7 Middle-Name
Person #7 Last-Name *
Person #7 Gender *
Person #7 Age-Category *

Person #7 Adult (16 and Over)
Person #7 Birthdate Adult 16 & Over *

Month Day Year
Person #7 Permissions (Child 12-15)
Person #7 Birthdate Child 12-15 *

Month Day Year
Person #7 Allow *
By selecting "YES" you are giving permission for this Child to enter the pool facility without an accompanying Adult.
By checking the appropriate box below and submitting this form, you represent that you are the parent/legal guardian of the child(ren) listed above and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
Please confirm that you are granting this permission for the Child listed as Person #7 *

Yes
Person #7 Permissions (Child under 12)
Person #7 Birthdate Child under 12 *

Month Day Year
The Child listed as Person #1 is under the age of 12 and must ALWAYS be accompanied by an Adult.
Please confirm that you acknowledge this stipulation for the Child listed as Person #7 *

Yes.
Person #7 Photo -
A photo must be on file for all pool members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB. Members will not be admitted to the pool without a photo on file .
Person #7 Photo Attachment *
Add Person 8?

Yes

Person #8 Information
Age-Category – Based on age as of May 28, 2022. Birthdate – Required for all Pool Members. Allow – Children between the ages of 12-15 may use the pool without an Adult provided that the “YES” box is checked below. If this box is not checked, that child will not be permitted into the pool unless with an Adult 16 years of age or older.
Person #8 First-Name *
Person #8 Middle-Name
Person #8 Last-Name *
Person #8 Gender *
Person #8 Age-Category *

Person #8 Adult (16 and Over)
Person #8 Birthdate Adult 16 & Over *

Month Day Year
Person #8 Permissions (Child 12-15)
Person #8 Birthdate Child 12-15 *

Month Day Year
Person #8 Allow *
By selecting "YES" you are giving permission for this Child to enter the pool facility without an accompanying Adult.
By checking the appropriate box below and submitting this form, you represent that you are the parent/legal guardian of the child(ren) listed above and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
Please confirm that you are granting this permission for the Child listed as Person #8 *

Yes
Person #8 Permissions (Child under 12)
Person #8 Birthdate Child under 12 *

Month Day Year
The Child listed as Person #1 is under the age of 12 and must ALWAYS be accompanied by an Adult.
Please confirm that you acknowledge this stipulation for the Child listed as Person #8 *

Yes.
Person #8 Photo -
A photo must be on file for all pool members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB. Members will not be admitted to the pool without a photo on file .
Person #8 Photo Attachment *
Add Person 9?

Yes

Person #9 Information
Age-Category – Based on age as of May 28, 2022. Birthdate – Required for all Pool Members. Allow – Children between the ages of 12-15 may use the pool without an Adult provided that the “YES” box is checked below. If this box is not checked, that child will not be permitted into the pool unless with an Adult 16 years of age or older.
Person #9 First-Name *
Person #9 Middle-Name
Person #9 Last-Name *
Person #9 Gender *
Person #9 Age-Category *

Person #9 Adult (16 and Over)
Person #9 Birthdate Adult 16 & Over *

Month Day Year
Person #9 Permissions (Child 12-15)
Person #9 Birthdate Child 12-15 *

Month Day Year
Person #9 Allow *
By selecting "YES" you are giving permission for this Child to enter the pool facility without an accompanying Adult.
By checking the appropriate box below and submitting this form, you represent that you are the parent/legal guardian of the child(ren) listed above and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
Please confirm that you are granting this permission for the Child listed as Person #9 *

Yes
Person #9 Permissions (Child under 12)
Person #9 Birthdate Child under 12 *

Month Day Year
The Child listed as Person #1 is under the age of 12 and must ALWAYS be accompanied by an Adult.
Please confirm that you acknowledge this stipulation for the Child listed as Person #9 *

Yes.
Person #9 Photo -
A photo must be on file for all pool members who are 3 years of age or older as of the date of pool opening. Please note that the picture must clearly show that person’s face (portrait-shaped head shot) and must be a .jpg file not larger than 1 MB. Members will not be admitted to the pool without a photo on file .
Person #9 Photo Attachment *

PURCHASE - Outside Pool Membership -
_______________________________________ A limited number of outside memberships can be purchased on a first come, first served basis: Up to 2 people: $200 ( Note, one person must be 18 years of age or older ) 3-5 people: $400 ( Note, one person must be 18 years of age or older ) 6+ people: $400 plus $50 per person beyond 5 ( Note, one person must be 18 years of age or older ) An Outside Membership does not need to be purchased for anyone who is under 3 years of age as of September 5, 2022. An application will not be considered to have been submitted until all required information (including pictures) is provided. Completed applications will be processed on a first come, first served basis. _______________________________________
Please confirm below that you wish to Purchase Outside Pool Membership(s)
Do you want to Purchase Outside Pool Membership(s) *

Yes No
Number of Individuals over 3 years old *
Please Confirm Purchase of Outside Membership *

OK
PURCHASE - Replacement Passes
Each Manchester Farm and Destiny Road household will receive 1 free Guest Pass good for 10 visits. Outside pool members and members who wish to purchase additional Guest Passes may do so for $50 each (each pass is good for 10 visits).
Guest Passes may be purchased for $50 each.
Do you want to Purchase Additional Guest Passes *

Yes No
Enter Quantity of additional Guest Passes *
* Each Pass is good for 10 visits.
Need to Replace lost or stolen Passes ($10 fee per Pass) *

Yes No
Enter Quantity of Replacement Passes *
Do you want to Replace lost or stolen Permanent Guest Pass ($10 fee). *

Yes No
Enter Quantity of Replacement Permanent Guest Passes *
TOTAL TO BE BILLED
Includes all varieties of Passes that you selected on this Form.

EMERGENCY CONTACTS ( Minimum of one required )
Contact #1 Name *
Contact #1 Daytime Phone *
Contact #2 Name
Contact #2 Daytime Phone
Comments

2022 SWIMMING POOL PASS PERMISSION FOR CHILDREN AGES 12-15 YEARS OLD - Children between the ages of 12-15 may attend the pool without an Adult, provided that the appropriate "Allow" (ie, allowed to use the Pool without an accompanying Adult) box is marked "Yes". By checking the appropriate box and signing this form, you represent that you are the parent/legal guardian of the child(ren) listed and give your permission for your child(ren) to use the Manchester Farm Community Association pool and related facilities while you are not in attendance. You have read and reviewed the Rules and Regulations with your child(ren). You and your children understand and agree to abide by the Rules and Regulations.
GENERAL PROVISIONS - You understand that the Manchester Farm Community Association, its agents, assistants, volunteers, or contractors assume no responsibility for any accident or injury that may occur in connection with the use of the pool or related facilities. Persons using the pool and related facilities agree to waive any and all claims and causes of action against Manchester Farm Community Association, its agents, assistants, volunteers, or contractors.
In consideration of using the Manchester Farm Community Association pool, the Membership Holder(s) agree(s) to abide by the Association's Rules and Regulations regarding the pool and related facilities:
I agree to all the Terms & Conditions listed above *

Yes

Please re-confirm that you accept all the Terms & Conditions of this Application: *

Yes, I do accept all the Terms & Conditions of this Application
For your approval signature, use your mouse or touch pad to sign this form:
Signature *

You have completed the application.

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Should you have any questions, contact TMGA at

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TOTAL TO BE BILLED

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USD Manchester Farm Pool Pass Purchases
Should be Empty:

Person #1 Adult (16 and Over)

Person #1 Permissions (Child 12-15)

Person #1 Permissions (Child under 12)

Person #2 Adult (16 and Over)

Person #2 Permissions (Child 12-15)

Person #2 Permissions (Child under 12)