Hatfield's High Dive Application

Hatfield's High Dive

302 Pool Street, Princeton, NC 27569

919-223-4434
HATFIELD'S HIGHDIVE POOL APPLICATION FORM
Important Information:

Please complete this form in its entirety. This must be completed before you select your summer plan online. Summer plan options can be viewed through our website. Summer fee payment can be made by check, cash, or through Venmo after application is processed. Make checks payable to Hatfield's High Dive and mail to: 202 S Claiborne St. Goldsboro NC 27530. If you would like to pay by cash or check you may do so at the pool. Contact owner if you need help to process Venmo payment. 919-223-4434
Personal Data

Tell us about yourself
Adult #1 Full Name

First NameLast Name
Relationship to household
Adult #2 Full Name

First NameLast Name
Relationship to household
Child's Name

First NameLast Name
Age:
Child's Name

First NameLast Name
Age:
Child's Name

First NameLast Name
Age:
Child's Name

First NameLast Name
Age:
Child's Name

First NameLast Name
Age:
Child's Name

First NameLast Name
Age:
Sitter 's Name

First NameLast Name
Age:
Grandparent 1

First NameLast Name
Grandparent 2

First NameLast Name
Children must be 12 years old to be dropped off at the pool without a parent, sibling or babysitter. Parental consent form must be complete.
Adult #1 Mobile No
Adult #1 Work No
Adult #2 Mobile No
Adult #2 Work No
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email *
Where the confirmation will be send to
Emergency Contact *

First NameLast Name
Emergency Contact No*
Health Information: Please list any health or allergy information that would be important for our lifeguards to know about your family members. Please list as (Name/Allergy-health info)*
If not any please type "n/a"
Consent for Underage Swimmer drop off without Adult Supervision-Ages 12-17
Child's Name
Age
Level of Swim: Beginner/Intermediate/Advanced
Applicant's Signature
By signing the space below, you are agreeing to allowing the child(ren) listed above to swim unattended and will not hold Hatfield's High Dive liable for any accidents or injuries that could occur. I understand that if my child's behavior causes him/her to lose this privilege I will be contacted to pick up my child. I understand that if my child must be picked up a second time they will not be allowed to attend without supervision for the rest of the season.

I have read and understand all of the pool rules and agree to follow them.
Signature

Clear
Disclosures:

In case of inclement weather pool closures will be announced on Hatfield’s High Dive Facebook page.

Hatfield’s High Dive is not responsible for lost, stolen or broken items brought to the pool.

Hatfield’s High Dive is not responsible for accidents or injuries caused by negligent behavior, rough play, or from not heeding safety warnings given by lifeguards.

The lifeguard has the final say. If for any reason the lifeguard sees fit to ask a member or guest to dismiss from the pool, the member or guest will do so. Admittance back to the pool will not resume until the next business day.
Summer Plan Selected*

Family PassCouples PassSingle PassPrepaid Guest Pass (5)Prepaid Guest Pass (10)
Summer Fee Payment made by*

CheckCashVenmo
Hatfield's High Dive has the right to decline applications for membership.
Should be Empty:

HATFIELD'S HIGHDIVE POOL APPLICATION FORM

Personal Data

Consent for Underage Swimmer drop off without Adult Supervision-Ages 12-17

Applicant's Signature

Hatfield's High Dive has the right to decline applications for membership.