STAGE 2 RESTRICTIONS

STILLHOUSE HOLLOW LAKE IS AT 65.2% (APRIL 15) LAKE GEORGETOWN IS AT 78.9% (APRIL 15)

Brushy Creek Pools : Recreation Pass Application

Recreation Pass Application (Swim, Tennis)

Please fill out the following form to register for a Swim Pass, Tennis Pass, and/or an Aerobic Pass at the Brushy Creek Community Center. Once you click the submit button below, your request will be sent to Customer Service who will contact you within one business day to collect payment information.

APPLICANT INFORMATION:
Last Name:		First Name:		M.I.:
Street Name:		City:		Zip:
Home Phone:		Cell Phone:		DOB:
Email Address:		Allergies:		Sex:	M F

Would you like to receive information from the Community Center via email? Yes No

EMERGENCY INFORMATION:
Name:		Phone:		Relation:
Name:		Phone:		Relation:

FAMILY MEMBERS:
Last Name	First Name	Birth Date	Sex	Allergies
			Male Female
			Male Female
			Male Female
			Male Female
			Male Female
			Male Female
			Male Female
			Male Female

*PASS TYPE AND PRICING :**
Annual Pool Pass:		Resident	Non-Resident
Individual		$30	$60
Family		$100	$200
Annual Tennis Pass:
Family		$25	$40
Aerobic Pass:
Individual ^		$40	$60
^ Pass expires after 3 months or 10 classes.
* No refunds will be issued for passes. Replacement cards are provided at a cost of $5.00 each
Release in use of District Facilities: In consideration of the privileges afforded to me by the Brushy Creek Municipal Utility District for the use of District parks and recreational facilities, I hereby assume all risks of personal injury or death and property damage or loss from whatever causes arising while on the premises of the swimming pool, tennis courts, and other park and recreational facilities furnished and operated by the Brushy Creek Municipal Utility District and further hereby release said District, its officers, employees, agents and servants from any liability therefore or for contribution as a joint tortfeasor therefore, and will indemnify and save harmless said Brushy Creek Municipal Utility District, its officers, employees, agents and servants from any such liability or contribution to such liability. In further consideration of the use with my permission of any of said District's parks and recreational facilities by my minor child or children or any minor child under my care of custody and by any other person or to any person or estate of any person as the result of personal injury, death, or property damage occurring while any person other than I is using District park and recreational facilities with my permission. My undertakings and waivers herein are expressly given in consideration of the issuance of the privilege to use the above described premises and facilities by the Brushy Creek Municipal Utility District. By signing below I agree to the terms and conditions listed above and the Brushy Creek rules and regulations. Brushy Creek Park and Pool Rules I agree to the Release in use of District Facilities and the Brushy Creek Park & Pool Rules: Signature: Date:

Customer Service will call you to obtain payment information.