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HEARTLAND COMMUNITY ASSOCIATION, INC.

AMENITY ACCESS AND USE AUTHORIZATION

The undersigned owner of the referenced property authorizes issuance of Amenity Access credentials normally provided to the owner of this property to the property occupant(s) listed and authorizes their use of Amenities under the property owner's membership. The undersigned owner acknowledges responsibility for the actions of his/her property occupants and their guests under the provisions of the Community Documents, understands that the property owner is responsible for any replacement of lost or damaged Amenity Access Cards (if utilized), and understands that the Community Association has no responsibility to collect any deposits from - or otherwise secure Amenity Access Card(s) for the property owner.

This authorization must be completed by the property owner and submitted to the Heartland Community Association together with the Amenity Access Waivers being completed by tenants. 


First Property Owner Name

First Name*

Last Name*

Phone*
First Property Owner Age Acknowledgment*
First Property Owner Date of Birth*
I certify that I am 18 years of age or older
First Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
First Property Owner Signature*
Second Property Owner Name

First Name*

Last Name*
Second Property Owner Date of Birth*
Second Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
Third Property Owner Name

First Name*

Last Name*
Third Property Owner Date of Birth*
Third Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
Fourth Property Owner Name

First Name*

Last Name*
Fourth Property Owner Date of Birth*
Fourth Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
Fifth Property Owner Name

First Name*

Last Name*
Fifth Property Owner Date of Birth*
Fifth Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
Sixth Property Owner Name

First Name*

Last Name*
Sixth Property Owner Date of Birth*
Sixth Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
Seventh Property Owner Name

First Name*

Last Name*
Seventh Property Owner Date of Birth*
Seventh Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
Eighth Property Owner Name

First Name*

Last Name*
Eighth Property Owner Date of Birth*
Eighth Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
Ninth Property Owner Name

First Name*

Last Name*
Ninth Property Owner Date of Birth*
Ninth Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
Tenth Property Owner Name

First Name*

Last Name*
Tenth Property Owner Date of Birth*
Tenth Property Owner Address

Address of homeowner (NOT the Heartland address being rented). *
Parent or Guardian's Email Address

Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Homeowner Identification - REQUIRED

Please upload a copy of the homeowner's current government-issued ID or driver's license. 

This form is to be completed by the owner of the property. Submissions by residents or lease holders will not be accepted.

  
*
Valid file types: JPG, GIF, PNG, and PDF
Property Tenant Information

Property Occupant/Lease Holder Names *

Heartland Property Address *
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Address

Address of homeowner (NOT the Heartland address being rented). *
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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