CRESTWOOD SWIM CLUB 2015 APPLICATION/WAIVER
Family Name: ______________________________
Address: ______________________________________________________Zip____________
Phone: (Home)_____________________________(Cell)_________________________________
E-mail address: _________________________________________________________________
In case of emergency, please contact:___________________________Phone_________________
Full Name of each family member
Birth date of each family member
Age of each family member as
of May 25,2015
AGREEMENT TO RELEASE AND HOLD CRESTWOOD SWIM CLUB HARMLESS
In consideration of the Clubs permitting the names mentioned above in all programs offered at Crestwood Swim
Club, We agree as follows:
1. We as our families and our personal representatives, release and discharge the Crestwood Swim Club, and/or
Rosebrook Real Estate, its agents, officers and employees, from all claims for personal injury, damaged or loss
of property, liability or expense, including attorney’s fees, arising out of our families or individual participation in
any programs not withstanding any claim of fault or negligence (whether sole, concurrent or otherwise) on the
part of Crestwood Swim Club and/or Rosebrook Real Estate its agents or employees.
2. We and our personal representatives, agree to defend, indemnify and hold the Crestwood Swim Club and/or
Rosebrook Real Estate, its agents, officers and employees, harmless against all claims which may be asserted by
others for personal injury, damage or loss to property, liability or expense, including attorney’s fees, occasioned
by any of our acts or omissions not withstanding any claim of fault or negligence (whether sole, concurrent of
otherwise) on the part of the Crestwood Swim Club and/or Rosebrook Real Estate, its agents, officers or
employees.
3. We do hereby grant and give the Crestwood Swim Club and/or Rosebrook Realty the right to use my or my
child’s and/or family’s photograph or image for any publications or promotions of the activities of facilities of the
Crestwood Swim Club and/or Rosebrook Real Estate.
4. All members listed above must live in the same household. Any falsification of information on this application
will require immediate expulsion without a refund.
_____________________________
Signature of an adult Family member
_______________________________________
Please PRINT name of signature
Membership checks should be made payable to: Crestwood Swim Club
Crestwood Swim Club
P.O. Box 29470
St. Louis, MO 63126
___________
Date
2015 CRESTWOOD SWIM CLUB
Membership/Registration: Due May 25, 2015
Early Payment (by May 1st): In order to qualify for the early payment discount, your
membership must be paid in full and postmarked by May 1, 2015. (Please note the price
difference after May 1, 2015).
2015 Membership Fees:
by May 1st
after May 1st
Stockholder Family Membership
$445.00
$505.00
Non-stockholder Family Membership
$575.00
$635.00
Stockholder Single Membership
$225.00
$275.00
Non Stockholder Single Membership
$295.00
$345.00
Stockholder 60+ Membership
$165.00
$220.00
Non Stockholder 60+ Membership
$225.00
$275.00
Guest Passes – Ten Passes
$ 50.00 (advance purchase only)
Payment Plan Option:
Four equal payments starting February 1, March 1, April 1, and May 1 to be the last payment
*No refunds on payment plan
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All membership fees include sales tax
Single memberships are for ages 15 and over.
There is a fee for any returned checks.
Membership fees will not be refunded after opening date.
Please note separate checks for first time stock purchase and pool membership fees
One Time Stock Fee to become a Stockholder
$160.00
Become a stockholder with a one-time stock fee of $160 and reap the benefits with a lower
membership fee this year and years to come.
Stockholder checks payable to:
Rosebrook Realty Co
Pool Membership checks payable to:
Crestwood Swim Club
Signed Waiver (on application): Our insurance carrier requires Crestwood Swim Club to maintain a
signed waiver for every membership. Please print and complete the application, sign the waiver and
mail with your payment.
If you have any questions, please contact Regina Massie ([email protected])
Complete your membership forms and mail to Crestwood Swim Club's PO Box below.
Crestwood Swim Club
PO Box 29470
St. Louis, MO 63126