Strasburg Pool Registration Form

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Current Season
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CurrentDate
Date
Month
Day
Year
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What type of membership would you like?Select "Family" if you are registering for yourself and your family. Select "Senior Citizen" if you are 60 or over. Finally, Select "Individual" if you want a membership just for yourself.
Family (Up to 10 directly related people)
Senior Citizen (Age 60+)
Individual (Just You)
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How many people would you like to register?* This field is required.Please choose up to 10 people. NOTE: If you are purchasing a Senior Citizen membership, please select "1" or "2".
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How many of the people you are registering are 3 or under?* This field is required.Please choose up to 8 children who will be 3 or under during the pool season.
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Would you like to add a Nanny to your membership?* This field is required.Cost: $50 Having a nanny assigned to your membership allows your babysitter or nanny to bring the children under 18 in your membership without having you be present. The Nanny can also use guest passes on your membership account.
YESNO
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Would you like to add guest passes to your account?Buy a pack of 10 guest passes and save $20! Guest passed are sold in a pack of 10 and cost $60. If you select "YES", $60 will be added to your total Order. Only a pack of 10 is available for purchase upon registering, but you can choose to purchase more guest passes for $8 each ($80 for 10) at the main counter during the pool season.
YESNO
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Total Participants
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Total Participants
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Participants Under 3
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Number of Paid Participants
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Your name* This field is required.Please enter your name here. you will be the first member of your membership.
First Name
Last Name
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Your Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
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District of Columbia
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Hawaii
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Louisiana
Maine
Maryland
Massachusetts
Michigan
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Mississippi
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Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Your Date Of Birth.* This field is required.Please enter your date of birth
Date
Month
Day
Year
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Member1AgeMember1Age
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Your Phone / Emergency Contact* This field is required.
Please enter a valid phone number.
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Your Email* This field is required.This email is where you will receive information about your membership, your membership receipt, and occasional newsletter emails.
your_email@gmail.com
Confirm Email
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Nanny nameEnter the name of the second person in your membership.
First Name
Last Name
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Member 2 name* This field is required.Enter the name of the second person in your membership.
First Name
Last Name
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Member 2 Date Of Birth* This field is required.Please enter the date of birth for this member.
Date
Month
Day
Year
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Member2AgeMember1Age
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Member 3 name* This field is required.Enter the name of the third person in your membership.
First Name
Last Name
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Member 3 Date Of Birth* This field is required.Please enter the date of birth for this member.
Date
Month
Day
Year
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Member 4 name* This field is required.Enter the name of the fourth person in your membership.
First Name
Last Name
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Member 4 Date Of Birth* This field is required.Please enter the date of birth for this member.
Date
Month
Day
Year
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Member 5 name* This field is required.Enter the name of the fifth person in your membership
First Name
Last Name
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Member 5 Date Of Birth* This field is required.Please enter the date of birth for this member.
Date
Month
Day
Year
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Member 6 name* This field is required.Enter the name of the Sixth person in your membership
First Name
Last Name
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Member 6 Date Of Birth* This field is required.Please enter the date of birth for this member.
Date
Month
Day
Year
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Member 7 name* This field is required.Enter the name of the Seventh person in your membership
First Name
Last Name
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Member 7 Date Of Birth* This field is required.Please enter the date of birth for this member.
Date
Month
Day
Year
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Member 8 name* This field is required.Enter the name of the Eighth person in your membership
First Name
Last Name
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Member 8 Date Of Birth* This field is required.Please enter the date of birth for this member.
Date
Month
Day
Year
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Member 9 name* This field is required.Enter the name of the Ninth person in your membership
First Name
Last Name
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Member 9 Date Of Birth* This field is required.Please enter the date of birth for this member.
Date
Month
Day
Year
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Member 10 name* This field is required.Enter the name of the Tenth person in your membership
First Name
Last Name
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Member 10 Date Of Birth* This field is required.Please enter the date of birth for this member.
Date
Month
Day
Year
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WAIVER AND RELEASE OF LIABILITY

In consideration of the risk of injury while participating in:Pool activities - to include, swimming, diving, cooking, sports, running, and all activities performed within pool premises. (the “Activity”), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Strasburg Swimming and Recreation Association, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS’ NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY.

I agree to indemnify and hold harmless Strasburg Swimming and Recreation Association against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If Strasburg Swimming and Recreation Association incurs any of these types of expenses, I agree to reimburse.

I acknowledge that Strasburg Swimming and Recreation Association and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Strasburg Swimming and Recreation Association.

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS “WAIVER AND RELEASE” AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE Strasburg Swimming and Recreation Association AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST Strasburg Swimming and Recreation Association FOR PERSONAL INJURY OR PROPERTY DAMAGE.

In the event that any damage to equipment or facilities occurs as a result of my or my family’s willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.

This Agreement was entered into at arm’s-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the Participant and Strasburg Swimming and Recreation Association agree that this agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.

Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.

Strasburg Swimming and Recreation Association has put in place preventative measures to reduce the spread of COVID-19; however, Strasburg Swimming and Recreation Association cannot guarantee that you or your child(ren) or other family members will not become infected with COVID-19. Further, attending Strasburg Swimming and Recreation Association's premises could increase your risk and your child(ren)’s risk of contracting COVID-19.

By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending Strasburg Swimming and Recreation Association and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Strasburg Swimming and Recreation Association may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Strasburg Swimming and Recreation Association employees, volunteers, and program participants and their families.

I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance at Strasburg Swimming and Recreation Association or participation in programming (“Claims”). On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless Strasburg Swimming and Recreation Association, its employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of Strasburg Swimming and Recreation Association, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any Strasburg Swimming and Recreation Association program.

BY REGISTERING AND PAYING FOR ANY MEMBERSHIP, CLASS, EVENT, PRIVATE LESSON, OR OTHER ACTIVITY THROUGH THIS WEBSITE, YOU ARE AGREEING TO ALL OF THE ABOVE CONDITIONS AND WAIVERS. PLEASE DO NOT HAVE YOUR FAMILY/YOURSELF PARTICIPATE IN ANY CLASS OR EVENT UNLESS YOU ACCEPT AND AGREE TO ALL OF THE TERMS IN THIS AGREEMENT.

I ACKNOWLEDGE THAT ALL MEMBERS OF MY MEMBERSHIP ARE REPRESENTED AND HAVE AGREED TO ALL OF THE ABOVE
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Please Sign here to Indicate that you've agreed to the Waiver and Release of Liability* This field is required.
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ALL members have read, understand, and agree to the Waiver and Release of Liability statement.* This field is required.
YESNO
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You cannot aquire membership if you do not select "YES" on this question. If you still do not want to select "YES" to this question, please close this registration form.
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ADMISSION

ALL MEMBERS MUST HAVE AN ACTIVE MEMBERSHIP TO GET INTO THE POOL

ALL GUESTS WALL PAY A FEE AT THE ENTRANCE, OR HAVE A GUEST PASS MUST BE USED

CHILDREN UNDER 10 YEARS OF AGE MUST BE WITH AN ADULT AT THE POOL

CHILDREN BETWEEN THE AGES OF 10-14 YEARS OLD MUST PASS A SWIM TEST TO

COME WITHOUT AN ADULT (SWIM 100 YARDS AND TREAD WATER FOR 2 MINUTES)

SWIMMING TRUNKS AND BATHING SUITS ARE REQUIRED (NO CUTOFFS)

NO PERSON UNDER THE INFLUENCE OF INTOXICATING BEVERAGES OR OTHER CONTROLLED OR INTOXICATING SUBSTANCES WILL BE PERMITTED ON THE PREMISES.

THE POOL IS NOT RESPONSIBLE FOR LOST OR STOLEN PROPERTY.

BABY POOL

THE BABY POOL IS FOR CHILDREN 5 YEARS OLD AND YOUNGER.

ALL CHILDREN USING THIS POOL WILL BE UNDER THE SUPERVISION OF AN ADULT AND KEPT UNDER THEIR CONTROL

ALL CHILDREN STILL WEARING DIAPERS MUST WEAR SWIM DIAPERS. (AVAILABLE FOR PURCHASE AT SNACK BAR)

NO INNER TUBES ALLOWED IN THIS POOL

GENERAL

NO RUNNING INTO POOL OR ON CEMENT

NO FOUL LANGUAGE

NO CHICKEN FIGHTING, HORSEPLAY, OR WRESTLING IN THE POOL

ARGUMENTS BETWEEN MEMBERS OR WITH STAFF WILL NOT BE TOLERATED

ANY ACTION BY ANY MEMBER THAT IS INTENDED TO CAUSE HARM OR HAMPER SAFETY WILL NOT BE TOLERATED

NO RAFTS IN THE POOL EXCEPT FOR SPECIAL EVENTS

ARM FLOATS, NOODLES , NERF BALLS AND SMALL TUBES ARE ALLOWED IN THE BIG POOL WITH THE LIFEGUARDS PERMISSION

NO GLASS CONTAINERS OR ALCOHOL ON THE POOL PROPERTY

TOBACCO USE IS ALLOWED OUTSIDE OF THE POOL PROPERTY AND AT LEAST 50 FEET AWAY FROM THE POOL IN ALL DIRECTIONS

NO PETS ALLOWED ON POOL PROPERTY

SKATEBOARDS, ROLLERBLADES & BIKES CANNOT BE USED INSIDE THE FENCED AREA

ONLY AUTHORIZED PERSONS ARE ALLOWED IN THE SNACK BAR AND OFFICE AREA

DIVE IN DESIGNATED AREAS ONLY.

PLEASE PUT ALL TRASH IN THE CONTAINERS

FIRST OFFENSE - Warning From The Lifeguard.
SECOND OFFENSE - Sit For 15 Minutes.
THIRD OFFENSE - You Will Be Suspended From The Pool For The Remainder Of The Day: Minor's Parents Will Be Sent A Letter, text message, or phone call Explaining The Suspension.

FAILURE TO ADHERE TO THE ABOVE DISCIPLINARY ACTION AND / OR REPEATED OFFENSES WILL RESULT IN EXTENDED SUSPENSIONS FROM THE POOL AND FINALLY LOSS OF POOL MEMBERSHIP WITHOUT REFUND
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ALL members have read, understand, and agree to the rules of this membership* This field is required.
YESNO
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You cannot aquire membership if you do not select "YES" on this question. If you still do not want to select "YES" to this question, please close this registration form.
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Please list any allergies or medical conditions that you'd like us to be aware of.
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Please add any additional notes that you'd like us to be aware of.
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REFUND POLICY:

Paying for this membership indicates your commitment to adhere to the policies herein.

Because you are paying for a season membership, refunds for this membership are not typically given.

Strasburg Swimming and Recreation Association decides on membership refunds on a case by case basis.

Refunds for products not related to your membership can be given at the discretion of the acting manager on site.

Paying for this membership, even without submitting this form, indicates that you agree to this refund policy.
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Initial Costcalculate ticket price based on number of people
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Guest PassCost of guest pass if chosen
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GuestPassNumbernumber of passes to add if guest pass is chosen
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Nanny Costcalculate ticket price based on number of people
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Discountscalculate ticket price based on number of people
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Total Costcalculate ticket price based on number of people
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Cost
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Payment Amount* This field is required.PLEASE TAP THE SUBMIT BUTTON BELOW TO COMPLETE YOUR PAYMENT. Your membership will not be active until payment is completed.
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