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202 3 EA R L Y BIRD P R E - SALE S eason P ool Memberships
FEES INCREASE MAY 1, 2023
Adler Pool Season: Sat, May 27-Sun, Aug 6 ( Adler Pool After Aug 6th , Weekends Only thru Sept 4th) Riverside Pool Season: Sat, June 10-Sun, Aug 10
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Non-Residents $180 $255 $330 $390 $450
Residents $105 $180 $255 $315 $375
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Individuals I Family 2 person Family 3 person I Family 4 person Family 5 person I *Add'I person Senior (60 yrs +) 1 10 Visit Pass 20 Visit Pass
Pool Season Passes are individual passes Two adults (18 older) per Family Pass Pass sharing is not allowed You must have proof of Village Residency to receive Resident rates No Refunds once the season begins on May 28
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$60 $95
$65 $65 $85 $170
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$125 $250
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FIRST NAME:__________________
LAST NAME:_________________
ADDRESS:________________________
C ITY/STAT E: _ __________
BIRTHDAY:_______ HOME PHONE:___________ CELL PHONE:_____________
Are you a Village of Libertyville Resident: YES NO
EMAIL: _______________________
LAST NAME
FIRST NAME
BIRTHDAY
FEE
NEW PASS? YES or NO
Non-refundable, Non-Creditable, No Rolls Overs: Buyer acknowledges and agrees that all fees for pools passes, once paid, are: • non-refundable, for any reason, including if the pools are closed • non-creditable against other Village programs, fees or purchases; and for the 202 3 season only. Pool passes will not be rolled over to a future pool season. Please check the box to Acknowledge □ Payment: We accept Visa, MasterCard, Discover and American Express. Cash and Checks are also accepted (payable to Village of Libertyville). Credit card statement will show charge as being paid to ActiveNet-Libertyville. . . VISA :AIVIERICAN■ 10,sco';;J Cardholder Name: -�RESS
Authorization Signature:
Charge Amount: $
Account Number:
Expiration Date:
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eve:
Important Information: In consideration of The Village of Libertyville ("the Village") granting the Participant the right and opportunity to participate in the program(s) identified in this Registration Form ("Programs"), and other good and valuable consideration, the sufficiency of which is hereby acknowledged, the Participant, hereby agree as follows: Acknowledgement and Assumption of Risk of Injury: The Participant acknowledges that here is an inherent risk of injury in the Participant's participation in the Programs, and that, specifically and without limitation of the foregoing, the Programs may involve strenuous exertion or bodily contact that are hazardous recreational activities. The Participant acknowledges and agrees that they have sole responsibility, and the Village has no responsibility whatever, to determine whether the Participant is physically fit and otherwise able to participate in the Programs. The Participant agrees to assume the full risk of any injuries, including death, and at all costs, damages, and losses, including medical bills, that the Participant may sustain as a result of participating in the Programs, or as a result of the condition, maintenance, and use of any public property involved in the Programs. Waiver and Release of Claims for Injury: The Participant shall, and does hereby, waive, release, and relinquish all claims of every kind, including claims for personal injuries, known and unknown, present and future that the Participant may have against the Village and its officers, agents, servants, and employees, arising out of, connected with or in any way related to the Programs or the Participant's participation therein, or as a result of the condition, maintenance, and use of any public property involved in the Programs. Indemnity: The Participant shall, and does hereby, indemnify and hold harmless the Village and its officers, agents, servants, attorneys, and employees from and against any and all claims of every kind, including claims for personal injuries, known and unknown, present and future, that the Participant may have arising out of, connected with, or in any way related to the Programs or the Participant's participation therein, or as a result of the condition, maintenance, and use of any public property involved in the Programs. Interest: The Participant acknowledges and agrees that they have no fundamental property or liberty interest in participating in the Programs, and that their participation in the Programs is conditioned upon the Participant's compliance with all Village regulations and instructions concerning the Program. The Participants have read and fully understands this document and executes it of their own free will and without any reservation whatsoever. Photos and video footage are periodically taken of people participating in a Recreation program or activity, attending a class or event, or using Libertyville Recreation facilities or property. Please be aware that by registering for a program or class, participating in an activity, attending an event, or using Libertyville Recreation facilities or property, you permit the Libertyville Recreation Department to use these photos and video footage for promotional purposes in Department publications, advertising, marketing materials, brochures, event flyers, social media (Facebook, Twitter, lnstagram, Youtube) and the Department website without additional prior notice or permission. All photos and videos are property of the Libertyville Recreation Department.
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Date:
Signature of Parent/Guardian/Participant (18 years and older)
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