Recreation Pass Application (Swim, Tennis, Aerobic)

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:

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.