Lake Bluff Pool/Beach Registration

355 W. Washington Avenue Lake Bluff, Illinois 60044 • Phone 847-234-4150

PLEASE PRINT • YOU MUST FILL OUT FORM COMPLETELY OR PROCESSING WILL BE DELAYED REGISTER BEFORE APRIL 1 FOR EARLY BIRD RATES

Anyone 2 years or older by May 23 MUST get a pass for the pool. Have all members of your household sign up at the same time so the correct fee is applied. Family members must reside in the same household to be eligible for the family rate. Proof of address is required for residents.

Check what you are registering for each per person only

Anyone taking a dog to the Dog Beach must sign the Dog Responsibilities Contract on page 31. Resident Dog Beach Tag is $20. Non-Resident Dog Beach Tag is $350. Only one Beach Pass is necessary to admit everyone in household. Reprinted/lost Beach passes cost $5 each.

I, the undersigned, understand that passes must be used by individuals to whom issued and that misuse will be cause for removing pass from use. The undersigned understands that children ten years and under must be accompanied by an individual sixteen years or older to the pool and beach respectively. The undersigned and all above members agree to abide by all rules and restrictions established by the Lake Bluff Park District for all facilities used. I understand there is $5 replacement fee for lost or stolen pool passes and a $5 replacement fee for lost or stolen beach passes or beach dog tags. Refunds allowed only for medical disability or relocation reasons. Verification required. Memberships are not transferable.

Signature of Parent/Adult/Guardian Date

Would you like to make a donation to Friends of Lake Bluff Parks? Amount of donation $__________________ CVC#

Date CVC#

CIRCLE ONE: CASH CHECK

If you take a dog to the Beach, you must buy a tag and sign the Dog Beach Waiver and Release.