Form Center

2. Group Name*
4. Contact's Name
5. Contact's Email Address
7. Mailing/Billing Address for Invoice
9. City
10. State
11. Zip Code
13. Contact's Phone Number
15. Requested Date/Time (for one day use)
    Requested Date/Time (for one day use)

    Requested Date/Time (for one day use)
17. OR
19. Recurring Dates Requested
21. Day of the Week

    1. Monday
    2. Tuesday
    3. Wednesday
    4. Thursday
    5. Friday
22. Frequency

    1. Weekly
    2. Bi-Weekly
    3. Monthly
23. Start Date
    Start Date

    Start Date
24. End Date
    End Date

    End Date
26. Number of Attendees*
27. Payment*

    1. Pay in Advance
    2. Pay by Invoice (post visit)
    3. Pay day of visit via credit card

    The Aquatic Center can only accept payments via credit card. All other payment types must be handled by the main office.

29. Person Responsible for the Group*

31.  - The group rate is $5.00 per person

     - Daycares must bring sufficient staff to assist with supervision of the kids

     - Requests must be made at least one week in advance

     - All daycares/groups must have an approved request form with payment agreement on file prior to the visit

     - All daycares/groups must have a bus or vehicle on site in case of inclement weather. If we close the pool due to inclement weather, everyone must exit the facility and we do not have any covered spaces.

33. Aquatic Center management reserves the right to deny requests or change dates or times of the request based on availabliity.
35. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
37. Electronic Signature
Leave This Blank:


39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field