Rancho San Miguel Swim Club
Rancho San Miguel Swim Club
2727 San Carlos Drive Walnut Creek, CA 94598 www.rsmswimclub.org 925-939-0821
2017 NEW MEMBER APPLICATION AND AGREEMENT The undersigned hereby offer to purchase a L i f e t i m e membership in the Rancho San Miguel Swim Club, a nonprofit corporation, subject to the terms and conditions listed below. 1. The L i f e t i m e Membership Fee of $5000.00 must be submitted herewith. The Lifetime Membership e x c u s e s t h e m e m b e r s f r o m h a v i n g t o p a r t i c i p a t e i n a n y sponsored Annual Maintenance activities for the duration of the membership. Please submit payment in the form of a personal check payable to Rancho San Miguel Swim Club. In the event your application for L i f e t i m e membership is not approved, a l l fees submitted with this application will be returned to you within 10 days of the date of disapproval. 2. This membership is subject to the bylaws of the corporation now in effect or as amended hereafter, including but not limited to provisions for termination of the membership on death and cannot be willed or nonpayment of dues. 3. The membership purchased under this agreement shall not be assignable without the prior written consent of the Club. 4. I have read the By-Laws and the Rules of the Rancho San Miguel Swim Club (available online). I agree to be bound and to abide by the Bylaws and the Rules and regulations established for the use and enjoyment of the Club’s recreational facilities. 5. I recognize that there are risks inherent in the sport of swimming, which could result in paralyzing injuries or death. On behalf of myself and my family, I hereby agree to indemnify and hold harmless the Rancho San Miguel Swim Club (hereafter Swim Club), its officers, employees, volunteers, instructors, and agents against any liability for personal injury or property damage that may occur while participating at the Swim Club as a result of not only our own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas of the Swim Club. 6. I further certify that I and the members of my family are in good health and have no physical condition that would prevent participation at the Swim Club. Furthermore I agree to use our personal medical insurance as a primary medical coverage payment if accident or injury occurs. I consent to emergency medical treatment in the event such care is required.
Signature: _____________________________________
Date: ______________
Signature: _____________________________________
Date: ______________
Rancho San Miguel Family Membership Application
Page 1 of 2
Rancho San Miguel Family Membership Application Continued
NEW MEMBER INFORMATION Return Application (pages 1 & 2) With Payment To: RSM Membership Director: Jessyca Emelson 925-918-1717, 2727 San Carlos Drive, Walnut Creek, CA 94598 **PLEASE MAIL THE COMPLETED FORMS OR DROP THE COMPLETED FORMS AT THE CLUB’S MAILBOX, LOCATED BY MAIN ENTRANCE**
FAMILY INFORMATION Membership Type (check one): ❑ Individual ☐ Joint
Family Name For Membership:
Last Name:
First Name:
Spouse’s Last Name (if different):
Spouse’s First Name
Street Address:
City, State, Zip:
Home Phone:
E-mail:
CHILDREN’S NAMES
BIRTHDATE
FEES One Time L i f e t i m e Membership Fee
Subtotal:
$5000 _____ $5000
Total Enclosed with Application: $_________ Check #________ Make checks payable to: Rancho San Miguel Swim Club. Referred by (Family’s last name): _____________________
Page 2 of 2
2727 San Carlos Drive Walnut Creek, CA 94598 www.rsmswimclub.org 925-939-0821
2017 NEW MEMBER APPLICATION AND AGREEMENT The undersigned hereby offer to purchase a L i f e t i m e membership in the Rancho San Miguel Swim Club, a nonprofit corporation, subject to the terms and conditions listed below. 1. The L i f e t i m e Membership Fee of $5000.00 must be submitted herewith. The Lifetime Membership e x c u s e s t h e m e m b e r s f r o m h a v i n g t o p a r t i c i p a t e i n a n y sponsored Annual Maintenance activities for the duration of the membership. Please submit payment in the form of a personal check payable to Rancho San Miguel Swim Club. In the event your application for L i f e t i m e membership is not approved, a l l fees submitted with this application will be returned to you within 10 days of the date of disapproval. 2. This membership is subject to the bylaws of the corporation now in effect or as amended hereafter, including but not limited to provisions for termination of the membership on death and cannot be willed or nonpayment of dues. 3. The membership purchased under this agreement shall not be assignable without the prior written consent of the Club. 4. I have read the By-Laws and the Rules of the Rancho San Miguel Swim Club (available online). I agree to be bound and to abide by the Bylaws and the Rules and regulations established for the use and enjoyment of the Club’s recreational facilities. 5. I recognize that there are risks inherent in the sport of swimming, which could result in paralyzing injuries or death. On behalf of myself and my family, I hereby agree to indemnify and hold harmless the Rancho San Miguel Swim Club (hereafter Swim Club), its officers, employees, volunteers, instructors, and agents against any liability for personal injury or property damage that may occur while participating at the Swim Club as a result of not only our own actions, inactions, or negligence, but also from the actions, inactions, or negligence of others, the condition of the facilities, equipment, or areas of the Swim Club. 6. I further certify that I and the members of my family are in good health and have no physical condition that would prevent participation at the Swim Club. Furthermore I agree to use our personal medical insurance as a primary medical coverage payment if accident or injury occurs. I consent to emergency medical treatment in the event such care is required.
Signature: _____________________________________
Date: ______________
Signature: _____________________________________
Date: ______________
Rancho San Miguel Family Membership Application
Page 1 of 2
Rancho San Miguel Family Membership Application Continued
NEW MEMBER INFORMATION Return Application (pages 1 & 2) With Payment To: RSM Membership Director: Jessyca Emelson 925-918-1717, 2727 San Carlos Drive, Walnut Creek, CA 94598 **PLEASE MAIL THE COMPLETED FORMS OR DROP THE COMPLETED FORMS AT THE CLUB’S MAILBOX, LOCATED BY MAIN ENTRANCE**
FAMILY INFORMATION Membership Type (check one): ❑ Individual ☐ Joint
Family Name For Membership:
Last Name:
First Name:
Spouse’s Last Name (if different):
Spouse’s First Name
Street Address:
City, State, Zip:
Home Phone:
E-mail:
CHILDREN’S NAMES
BIRTHDATE
FEES One Time L i f e t i m e Membership Fee
Subtotal:
$5000 _____ $5000
Total Enclosed with Application: $_________ Check #________ Make checks payable to: Rancho San Miguel Swim Club. Referred by (Family’s last name): _____________________
Page 2 of 2
