Pool Use Agreement
Riverdale Dunes Metropolitan District No. 1
Property Street Address: *
Homeowner Name: *
Phone Number: *
Type of Phone:
*
Current Mailing Address (if other than the above listed property address)
Street Address:
City:
State:
Zip Code:
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Email Address:

Is the property currently being used as a rental property?
*
Pool Key #

Individuals (first and last name AND AGE) living at the above property address other than the property owners:
Note: You Must List all three pieces of information for each entry or the form will be rejected.
1. Resident's Full Name
Resident's Age
2. Resident's Full Name
Resident's Age
3. Resident's Full Name
Resident's Age
4. Resident's Full Name
Resident's Age
5. Resident's Full Name
Resident's Age
6. Resident's Full Name
Resident's Age
7. Resident's Full Name
Resident's Age
8. Resident's Full Name
Resident's Age
Note: Pool privileges will not be granted unless a "yes" response is provided to each statement.
 
*		    I have read and agree to abide by the District’s current pool rules.
 
*		    I will ensure all individuals living at this address and any guests will be made aware of the District’s current pool rules and will agree to abide by such rules before they enter the pool area.
 
*		    I acknowledge that failure to abide by the District’s current pool rules may result in suspension of pool privileges of some or all individuals living at this property address (including guests).
 
*		    I acknowledge the pool privileges for this property address may be suspended at any time by the District if the homeowners/residents fail to timely correct covenant violations on the lot as identified by the District.
 
*		    I acknowledge (1) the pool monitor is not a lifeguard and (2) I will inform all individuals living at this property address and related guests—before they enter the pool area—that the pool monitor is not a lifeguard.
By entering my email address and clicking submit, I certify that the above information is, to the best of my knowledge, true and accurate.
Email (required) *

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