2012 CLUB KIWI MEMBERSHIP FORM

IMPORTANT: Discounted prices are available for Town of Carmel/Mahopac residents. Please call the Town of Carmel Parks and Recreation Office at 845-628-7888 to enroll.

* First Name

* Last Name

* Address

* City

* State

* Zip

Phone

* Email Address

* Please select your enrollment type:

Single Membership

Family of 4 Membership

* Please select a membership option:

7 Days a Week Single ($400.00)

Weekends Only Single ($250.00)

Weekdays Only Single ($150.00)

* Please select a membership option:

7 Days a Week Family ($800.00)

Weekends Only Family ($400.00)

Weekdays Only Family ($600.00)

Additional Family Member Information

Member 2 Full Name:

Age:

Relationship:

Member 3 Full Name:

Age:

Relationship:

Member 4 Full Name:

Age:

Relationship:

* Emergency Contact Name:

* Emergency Contact Phone Number:

Rules & Regulations

1. Club Kiwi is open Monday – Friday from 4:30pm – 8:30pm. Saturday & Sunday 11:00am- 4:00pm ( 5 block out days) Memorial Day thru Labor Day.

2. Parking will be located at the field to the left of the pond.

3. Sign in will be on the pool deck. You must sign in everyday you attend and have picture ID.

4. No children under 18 permitted without parent.

5. No rain dates.

6. Guest passes must be purchased in advance in the Kiwi Office between 9:00am and 4:00pm. Price is $25 per pass and each guest is only permitted to attend twice per summer.

7. Absolutely no alcohol permitted on Kiwi property.

8. No food or beverages permitted on pool deck. There is a water cooler provided at the pool.

9. Not responsible for personal property left unattended.

10. Tennis will be a first come, first serve activity. If there are matches waiting to be played, matches will be limited to 30 minutes.

11. Mini golf will have 8 minute tee times or a shot-gun start schedule.

12. In the event of inclement weather, Please contact the office at 845-277-3876.

* Please enter your initials to affirm that you understand the rules and regulations of Club Kiwi

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