Homeowner name:
Spouse Name:
Residence Address:
This home is in:
Please select
your Subdivision
Bedford Downs
Foxfield
Foxfield Estates
Home phone (###-###-####):
Work phone (###-###-####):
Cell phone (###-###-####):
Spouse Cell phone (###-###-####):
E-mail address:
List the names and
ages of all children under the age of 18 Living at the above
address:
Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
Name:
Age:
It is understood and
acknowledged by the homes association member resident(s) named on
this form that:
There is no life guard or attendant on duty at the
Bedford Downs Homes Association
swimming pool facilities. Therefore, I/we acknowledge that any
member of my/our family and/or my/our guests use these
facilities at our own risk.
All children under the age of fourteen (14) must be
supervised by their parent or other adult guardian who is
eighteen (18) years or older at all times while at the
facilities.
We/I have received and read a copy of the Swimming Pool
Facilities Rules and Regulations and all members of this
family and guests will honor and abide by said Rules and
Regulations and any published changes thereof. It is
understood that violations of the Rules and Regulations may
result in the suspension of our family swimming pool
priviledges for a designated period of time.
Download/view
the Rules and Regulations now.
Release
By submitting this
form, I/we state I/we are members in good standing of the Bedford
Downs Homes Association, for the consideration and use of the
swimming pool facilities owned by Bedford Downs Homes Association
hereby acknowledge and release said Bedford Downs Homes
Association and their assigns, and all other persons, firms and
corporations, both known and unknown of and from any and all
claims, demands, causes of action or suits at law, which could
arise as a result of the use of said homes association swimming
pool facilities located at or about 12802 West 119th Terrace in
Overland Park, Kansas by the above named homeowner(s), including
members of that family and/or guests of that family. I/we
understand it will be my/our responsibility to properly conduct
myself/ourselves and comply with all the homes association's
"Swimming Pool Facilities Rules and Regulations," of
which I/we have received a copy and fully understand, in order to
avoid personal injury or property damage.
By agreeing to this release, you are stating you
have read the above release and the acknowledgement, have
completed this form accurately and truthfully and you and family
agree to abide the Rules and Regulations and this Release.
By disagreeing to this
release, you are stating you do not agree to the release and/or
the Rules and Regulations.
Select One
I Agree
I Disagree
Name of the person
submitting this form.
(Note: Only this submitter or the above named adult homeowner
is authorized to pick up the swipe card.)
Today's date (mm/dd/yyyy):