Swim Membership

Swim Membership Application & Renewal

Please fill out this application form for a swim-only membership. A swim-only membership is a seasonal option starting in April and continuing into October. Enjoy all swimming amenities as a member.

Step 1 of 2

Name

First Last

Primary Member(Required)

First Last

Spouse

First Last

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Mobile or Work Phone(Required)

Email(Required)

How did you hear about us?

Number of Children in Membership(Required)

Please note for more than three (3) children, there will be an additional $50.00 applied per additional child. Example: Child #4, Child #5 will each be $50 additional ($100 total).

Child Name #1(Required)

First and Last

Date of Birth - Child #1(Required)

Child Name #2(Required)

First and Last

Date of Birth - Child #2(Required)

Child Name #3(Required)

First and Last

Date of Birth - Child #3(Required)

Child Name #4(Required)

First and Last

Date of Birth - Child #4(Required)

Child Name #5(Required)

First and Last

Date of Birth - Child #5(Required)

Child Name #6(Required)

First and Last

Date of Birth - Child #6(Required)

Number of Child Care Providers(Required)

If you have child care providers, please provide their information. One (1) child care provider may be added to your account free of charge. Additional providers will be an additional $50.00 each.

Child Care Providers Name #1(Required)

First Last

Child Care Providers Name #2(Required)

First Last

Child Care Providers Name #3(Required)

First Last

Agreement to one (1) season minimum

By entering your initials below, you understand there is a one (1) season minimum obligation*(Required)

*If within three (3) working days after joining Wikiup Tennis & Swim Club you are not satisfied, for any reason, your Membership fee will be returned with no obligation.

WAIVER AND RELEASE AND ASSUMPTION OF RISK

Please Read(Required)

Applicable to Initial Membership and subsequent Renewals.

The undersigned recognizes the use of the facilities of Wikiup Tennis and Swim Club involves risks of physical injury, including that caused by the negligence of him/herself of Wikiup Tennis and Swim Club, its agents and employees. The undersigned hereby agrees to assume the risk of injury in its entirety regardless of the cause. You (buyer, each member and all guests) agree that if you engage in any physical exercise or activity or use any part of Wikiup Tennis and Swim Club’s facility or any if its affiliates or related entities, you do so at your own risk and assume the risk of any and all injury and/or damage while engaging in any physical exercise or activity or use of any part of club facility on the premises. Your assumption of risk includes, without limitation, your use of the locker room, sidewalk, parking lot, stairs, pool, lobby area, or any equipment in the Wikiup Tennis and Swim Club facility. Member agrees to assume the risks in his or her participation in any activity, class, program, instruction, or Wikiup Tennis and Swim Club sponsored event. You agree that you are voluntarily participating in the aforementioned activities and using the Wikiup Tennis and Swim Club facilities and premises and assume of all risk of injury, illness, damage, or loss to you or your property the might result, including, without limitation, any loss or theft of any personal property, including injuries or damages that might result from the negligence of Wikiup Tennis and Swim Club or any of its affiliates, employees, agents, representatives, successors, and assignees.

You agree on behalf of yourself (and all of your representatives, heirs, executors, administrators, agents, and assignees) to release and discharge Wikiup Tennis and Swim Club (and our affiliates, employees, agents, representatives, successors, and assignees) from any and all claims or causes of action (know and unknown) arising out of the negligence of Wikiup Tennis and Swim Club, or any of its affiliates, employees, agents, representatives, successors, and assignees. This waiver and release of liability includes, without limitation, injuries which may occur as a result of (a) your use of any equipment or facilities which may malfunction or break, (b) Wikiup Tennis and Swim Club’s improper maintenance of any equipment or facilities, (c) Wikiup Tennis and Swim Club negligent instruction or supervision, including personal training, and (d) you slipping and falling while on or in the facility or any portion of the premises for any reason, including Wikiup tennis and swim club negligent inspection or maintenance of its facility. By execution of this agreement, you hereby agree to indemnify and hold harmless Wikiup Tennis and Swim Club from any loss, liability, damage, or cost Wikiup Tennis and Swim Club may incur due to you presence at the Wikiup Tennis and Swim Club facility. You further expressly agree that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as permitted by the law I the State of California and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I authorize Wikiup Tennis and Swim Club or his/her authorized agent to consent to any medical treatment and/or hospital care, which is given to all persons, listed on his form and their guests, under the supervision of a duly licensed physician or trained medical personal. By signing this consent form I agree to allow all members and guests to participate in all Wikiup Tennis and Swim Club activities. I allow for photographs to be taken, while at the club, to be used for marketing purposes unless otherwise indicated in writing.

Member agrees and understands that management reserves the right to revoke the Agreement or Membership in Wikiup Tennis and Swim Club for member, or anyone on their membership, if member or responsibility fails to abide by all Rules and Regulations of the Club.

Member represents and warrants that member and responsibility are in good physical condition: that member responsibility has nothing preventing them from engaging in active or passive exercise or of any activity or service offered by Wikiup Tennis and Swim Club.

YOU ACKNOWLEDGE THAT YOU HAVE CAREFULLY READ THIS WAIVER AND RELEASE AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY, AND EXPRESS ASSUMPTION OF RISK AND INDEMNITY AGREEMENT. YOU ARE AWARE AND AGREE THAT BY EXECUTING THIS WAIVER AND RELEASE, YOU ARE GIVING UP YOUR RIGHT TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST WIKIUP TENNIS AND SWIM CLUB FOR IT’S NEGLIGENCE, OR ANY DEFECTIVE PRODUCT ON ITS PREMISES. YOU HAVE READ AND VOLUNTARILY SIGNED THE WAIVER AND RELEASE AND FURTHER AGREE THAT NO ORAL REPRSENTATIONS, STATEMENTS, OR INDUCEMENT APART FROM THE FOREGOiNG WRITTEN AGREEMENT HAVE BEEN MADE.

I authorize Wikiup Tennis and Swim Club or his/her authorized agent to consent any medical treatment and/or hospital care, which is given to the child, listed on this from, under the supervision of a duly licensed physician or trained medical personnel. Also, by signing this consent form I agree to allow the above minor to participate in all youth activities and for photographs to be used for marketing purposes unless otherwise indicated in writing. I also grant permission for my child to ride in any Wikiup Tennis and Swim Club transportation that is provided by the Wikiup Tennis and Swim Club.

I AGREE TO WIKIUP TENNIS AND SWIM CLUB WAIVER AND RELEASE AND ASSUMPTION OF RISK STATEMENT

Emergency Contact Name #1(Required)

First Last

Emergency Contact #1 Phone(Required)

Emergency Contact Name #2(Required)

First Last

Emergency Contact #2 Phone(Required)

Allergies, medical conditions or special needs we should be aware of:

E-Signature

By entering your full name and the date of completion of this form, you agree that this will serve as an electronic signature (E-Signature). Additionally you agree to the following: I certify that the above information is true & correct. I further certify that I have read and agree to the Wikiup Tennis and Swim Club Waiver and Release and Assumption of Risk statement.

Primary Member Name (E-Signature)(Required)

First Last

Date (E-Signature)

Proceed to the Next Step for completion of membership payment information.

Credit Card Authorization

Please fill out the Credit Card Authorization Form that will be used to automatically charge for your membership.

Name(Required)

Name on card

First Last

Email(Required)

Payment Type(Required)

Credit Card

Debit Card

I authorize Wikiup Tennis and Swim Club to initiate WEEKLY deductions from my account below for any goods and/or services charged during the week.

Card Number(Required)

Expiration Date(Required)

Security Code (V-Code)(Required)

Zip code(Required)

Consent & E-Signature

Name (E-Signature)(Required)

First Last

Date (E-Signature)(Required)