Milton Academy Pool Club - Enrollment Form

2013 MILTON ACADEMY POOL & TENNIS CLUB - ENROLLMENT FORM - G

Last Name ______First Name ______Family Name (as you wish it to appear on membership card)______

Address ______

City ______State ______Zip ______

Home Phone ______Work/Cell Phone ______

Adult Name ______Adult Name ______Names and ages of children: ______, ______, ______, ______Milton Academy Pool & Tennis Club: General Release on Liability, Assumption of Risk, and Covenant Not to Sue

In consideration of being permitted to participate in the Pool & Tennis Club (the “Activity”), I hereby assume all risks and dangers of the Activity in which, I, my family members, and invited guests, will be participating. I hereby release Trustees of Milton Academy, and its officers, trustees, agents and employees (collectively “Milton Academy”) from all actions, causes of actions, suits, and all claims, demands, and liabilities whatsoever, both in law and equity, which I may have or acquire against Milton Academy, arising from or in connection with any such Activity, and I covenant and agree that I will not bring any suit, action or claim of any kind against Milton Academy arising from or in connection with such activity.

I warrant that I am fully able to enter into this release on behalf of myself, my family members and invited guests and that this release also applies to my spouse/partner, my children, my heirs, assigns, personal representatives, and estate. I understand and agree that this release will be interpreted in accordance with the law of the Commonwealth of Massachusetts and that it will remain in effect until the end date of the Milton Academy Tennis & Pool Club, 2013.

Additionally, I understand that all of the rules posted at the pool and other designated areas on campus must be obeyed and that the lifeguard on duty is in charge of the pool at all times, and has the right to limit the number of people using the pool at any given time, and to make other decisions as are necessary to ensure a pleasant and safe pool environment. I acknowledge that children 13 and under must always be accompanied by a parent/guardian; children 14 and older will be allowed to swim without parental supervision, but will have this privilege revoked if they disobey pool rules, or are disruptive.

I have carefully read this agreement and fully understand its content. I am aware that this is a release of liability, that it is a contract between myself and Milton Academy and sign it on my own free will.

Signature ______Date ______Please check the membership you have chosen

___ FAMILY MEMBERSHIP $550

___ WEEKLY (#__ of weeks x $87) $87 per week Monday - Sunday Weeks Requested ______

___ INDIVIDUAL $240

___ DAILY PASSES (sold in increments of 5) $110

____ GUEST PASSES (sold in increments of 5) $ 30

Please return this form with a check for the full amount payable to Milton Academy to Business Services, Milton Academy, 170 Centre St, Milton MA, 02186