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2022 Pool Membership Form

  1. ADAMSTOWN COMMUNITY POOL - 2022 Online Registration
  2. ***WHEN FINISHED COMPLETING THIS FORM, PLEASE BE SURE TO CONTINUE TO MUNICIPAY PAGE TO MAKE YOUR PAYMENT***
  3. DEFINITION OF FAMILY MEMBERSHIP: Up to two (2) parents or legal guardians and four (4) children 18 or under living in the same household. Additional children ages 5-18 living in the same household are $30/child. Guest passes are available for purchase on the payment page.
  4. Please list names/ages of all members to receive pool passes below:
  5. Waiver*
    I have read and understand the Conduct and Safety Policies. I, and the members of my family, agree to follow them. I (we) also agree to follow the rules posted at the pool, and any special instructions given to me (us) by lifeguards. The information provided by me on this form is true and correct. ***I UNDERSTAND THAT FALSIFICATION OF RESIDENCY, AGE OR SCHOOL INFORMATION COULD RESULT IN THE SUSPENSION OF MY MEMBERSHIP WITH NO REFUND.*** SUBMISSION OF THIS FORM SERVES AS MY OFFICIAL SIGNATURE
  6. *** AFTER CLICKING 'SUBMIT' PLEASE BE SURE TO COMPLETE PAYMENT ON MUNICIPAY PAGE. IF PURCHASING GUEST PASSES, REMEMBER TO CLICK THEM ON THE PAYMENT PAGE AS WELL ***
  7. Leave This Blank:

  8. This field is not part of the form submission.