Adult Name(s):__________________________________ Address:________________________

Home Phone: _____________ Emergency Phone: ____________ Cell Phone: ______________

Children’s Name and Age ________________________ _________________________

.................................________________________ ________________________

Type of Membership: Individual ____ Family ____ Senior ____ Additional ____ (please check one)

I/We (family) have read and understand pool rules. (please initial) _______

Please mail this form back to Foxboro Recreation, 40 South St. and include your Medical Release form and sign below

Read and Sign Below: I am fully aware of the risks inherent and hereby give my consent for the above named applicant to participate in the programs offered by the Foxboro Recreation Dept. and hereby release the Town of Foxboro and its elected or appointed officials or instructors from any and all liability from injuries, claims, demands, costs, loss of services, expenses and or damages sustained by participant in said program or event.

Date_______________ Signature_________________________________________________