2025 Seasonal Membership Application to The Dauphin Pool

2025 Seasonal Membership Application
Please Note: This form is to purchase your seasonal membership online via a credit card or PayPal. If you wish to pay by check, please download the seasonal membership form and mail it in with your check. Additional Fees apply (PayPal transaction fees)
Membership Type*

Individual - $175.00 +PayPal feeFamily - $275 + PayPal Fee
Member Status

AdultChild
Member Name*

First NameLast Name
Child DOB

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Alt. Phone Number

Area CodePhone Number
E-mail *
Email 2
Emergency Contact

First NameLast Name
Emergency Phone #

Area CodePhone Number
Today's Date

MonthDayYear
FAMILY MEMBERSHIPS: ALL FAMILY MEMBERS ARE REQUIRED TO LIVE IN THE SAME HOUSE. Children (under the age of 21), attend college, or active military may be included in the Family Membership. Babysitters, children that do not meet the Family Membership guidelines, and grandparents MUST purchase an individual membership.

***We reserve the right to ask for proof of residency for anyone listed on the membership application. Anyone found in violation of this or submitting fraudulent information will have their membership revoked and fees WILL NOT be refunded.

***Each individual listed below must reside at the same address.
Adult #1*

First NameLast Name
Adult #2*

First NameLast Name
Number of Children
Children must be under 21 unless in college or active military.
Child #1 Name

First NameLast Name
Child#1 DOB

MonthDayYear
Child #2 Name

First NameLast Name
Child#2 DOB

MonthDayYear
Child #3 Name

First NameLast Name
Child#3 DOB

MonthDayYear
Child #4 Name

First NameLast Name
Child#4 DOB

MonthDayYear
Child #5 Name

First NameLast Name
Child#5 DOB

MonthDayYear
Would you be willing to volunteer for any of the following?

Events (help plan new events or organize special events)Grounds (mowing, tree trimming, painting)Maintenance (fixes around pool, handyman, plumbers, electricians)Publicity (promote the pool & events)I'm Interested in joining the volunteer pool boardOther
2025 MEMBERSHIP APPLICATION WAIVER OF LIABILITY

SIGNATURE REQUIRED BEFORE RECEIVING A MEMBERSHIP CARD.

I, {adultsName}, agree to abide by all the rules and regulations of the Dauphin Recreation Association.
I hereby waive all of the risks of participating in any/all activities associated with attending the pool property, any risks that may arise from negligence or carelessness on the part of the persons or entities being released, from dangerous or defective equipment or property owned, maintained or controlled by them, or because of their possible liability without fault. In consideration of my application and permitting to participate in this activity, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assigns as follows:

A. I WAIVE, RELEASE AND DISCHARGE from any and all liability, including but not limited to, liability arising from the negligence or fault of the entities or persons released, for my death, disability, personal injury, property damage, property theft,
or actions of any kind which may hereafter occur to me including my traveling to and from this activity, the following entities or persons: Dauphin Recreation Association (DRA) and/or their directors, officers, employees, volunteers, representatives, and agents and the activity holders, sponsors and volunteers.

B. INDEMNIFY, HOLD HARMLESS AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph (DRA) from any and all liabilities or claims made as a result of my negligence.

I acknowledge that DRA and their directors, officers, volunteers, representatives and agents are NOT responsible for the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their behalf.

The Accident Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I certify that I have read this document and I fully understand its content. I am aware
that this is a release of liability and a contract and I sign it of my own free will.
Signature*
Date*

MonthDayYear
Date
My Products (Choose one)
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Individual Membership $181.81
Includes PayPal fees

Family Membership$285.46
Includes PayPal Fees

Total $0.00
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