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2010 Riverwood Plantation Pool Dome Membership Name:_________________ Address:_______________ Phone Number: _____________ Email:___________________ Family Members: 1._______________2._______________ 3._______________4._______________ 5._______________6._______________ Emergency Contact: Name________________ Phone______________ • • •

All Pool Members are to adhere to the pool rules and regulations. All Pool Members are covered under the existing pool insurance policy. All members understand that Riverwood Pool , LLC and committee members are not responsible for any accident or injury resulting directly or indirectly by the use of the Riverwood Pool or amenities. ___________( print) do herby voluntarily release, discharge, waive, relinquish and covenant not to sue with respect to any and all actions or causes for bodily injury, either directly or indirectly out of utilizing or benefiting from the use of the Riverwood Pool and amenities. __________________ Signature of adult member Fees: Riverwood Plantation Residents/ASL/Greenbrier Swim Team Members September 1st-31st : $175 After October 1st: $200 Senior Citizen rate: $125 Non-Riverwood Plantation Resident September 1st -31st: $275 After October 1st: $300 Senior Citizen rate: $150 INFORMATION: CONTACT CAROL DUGGAN, POOL MANAGER, at carol@riverwoodplantation.com


2010 Riverwood Plantation Pool Dome Membership