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By signing this release, I/We hereby agree to defend, indemnify, hold harmless and release the Briarmoor Manor Recreation Club, its successors and/or assigns, its Board of Directors, Officers and Members (hereafter referred to as “The Club”) from any and all liability, losses (loss of life, limb, sight, etc.), damages and expenses incurred by and to myself, spouse, children, guest, invitees or any associates which might arise out of the use of any and all of the Briarmoor Manor Recreation Club facilities, particularly those facilities that are recreational in nature such as, but not limited to, the swimming pools, etc.


First Guest Name

First Name*

Last Name*

Phone*
First Guest Date of Birth*
First Guest is being hosted by:

Name of Member who is hosting Guest.
First Guest Signature*
Second Guest Name

First Name*

Last Name*
Second Guest Date of Birth*
Second Guest is being hosted by:

Name of Member who is hosting Guest.
Third Guest Name

First Name*

Last Name*
Third Guest Date of Birth*
Third Guest is being hosted by:

Name of Member who is hosting Guest.
Fourth Guest Name

First Name*

Last Name*
Fourth Guest Date of Birth*
Fourth Guest is being hosted by:

Name of Member who is hosting Guest.
Fifth Guest Name

First Name*

Last Name*
Fifth Guest Date of Birth*
Fifth Guest is being hosted by:

Name of Member who is hosting Guest.
Sixth Guest Name

First Name*

Last Name*
Sixth Guest Date of Birth*
Sixth Guest is being hosted by:

Name of Member who is hosting Guest.
Seventh Guest Name

First Name*

Last Name*
Seventh Guest Date of Birth*
Seventh Guest is being hosted by:

Name of Member who is hosting Guest.
Eighth Guest Name

First Name*

Last Name*
Eighth Guest Date of Birth*
Eighth Guest is being hosted by:

Name of Member who is hosting Guest.
Ninth Guest Name

First Name*

Last Name*
Ninth Guest Date of Birth*
Ninth Guest is being hosted by:

Name of Member who is hosting Guest.
Tenth Guest Name

First Name*

Last Name*
Tenth Guest Date of Birth*
Tenth Guest is being hosted by:

Name of Member who is hosting Guest.
Parent or Guardian Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*

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


Parent or Guardian Name

First Name*

Last Name*

Phone*
Parent or Guardian Date of Birth*
Parent or Guardian is being hosted by:

Name of Member who is hosting Guest.
Parent or Guardian 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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