WAC Membership Contract Please enable JavaScript in your browser to complete this form.Primary Responsible Party – Personal DataName *FirstLastBirthdateAgeGenderMaleFemaleBilling Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeNeeded for credit card processing.PhoneEmail *Preferred Method of ContactMailPhoneEmailEmployerEmployer PhoneSecondary Responsible Party – Personal DataMust be dependents living in the same household as Responsible Party.Name *FirstLastBirthdateAgeGenderMaleFemalePhoneEmail *EmployerEmployer PhoneFamily / Couple Pass (must be dependents living in the same household as Responsible Party) Dependent Children are under the age of 19.Dependent 1 NameDependent 1 Date of BirthDependent 1 Gender MaleFemaleDo You Want To Add Another Dependent?YesNoDependent 2 NameDependent 2 Date of BirthDependent 2 GenderMaleFemaleDo You Want To Add Another Dependent?YesNoDependent 3 NameDependent 3 Date of BirthDependent 3 GenderMaleFemaleDo You Want To Add Another Dependent?YesNoDependent 4 NameDependent 4 Date of BirthDependent 4 GenderMaleFemaleDo You Want To Add Another Dependent?YesNoDependent 5 NameDependent 5 Date of BirthDependent 5 GenderMaleFemaleDo You Want To Add Another Dependent?YesNoDependent 6 NameDependent 6 Date of BirthDependent 6 Gender MaleFemaleInitial *Clear SignatureI have received a copy of the Guidelines and Waiver of Liability, Monthly Automatic Payment Agreement and Member BenefitsWaiver of Liability INDEMNIFICATION AGREEMENT AND COVENANT NOT TO SUE NOTICE: This is a legally binding agreement. By signing this agreement, you give up your right to bring court action to recover compensation or obtain any other remedy for injuries to yourself or your property or for your death arising out of your use of the Worland Aquatic Center now or anytime in the future. Acknowledgement of risk: I, the undersigned user, hereby acknowledge and agree that the sport of swimming or any other activity associated with the use of the Worland Aquatic Center, located at 2250 Howell Ave. Worland, WY, 82401 poses inherent risks. I have full knowledge of the nature and extent of all of the risks associated with the use of the Worland Aquatic Center.DateSignatureClear SignatureMembership OptionsNOTICE - Any payment made online will have a 3.5% service charge added to their total. Membership Type Annual Fee Paid in Full Family* Military/Corporate $552 $504 Single Child 4-7 Military/Corporate $204 $180 Single Youth 8-11 Military/Corporate $252 $228 Single Student 12-18 Military/Corporate $276 $252 Adult Single 19-59 Military/Corporate $300 $276 Adult Couple** Military/Corporate $408 $360 Golden Single*** Military/Corporate $252 $228 Golden Couple*** Military/Corporate $300 $276 *Family members; must be dependents living in the same household as Responsible Party. **Adult Couple; must be two adults living in the same household. *** Golden Single/Couple; patrons age 60 and up. -MONTHLY PAYMENTS MUST BE SET UP AS AN AUTOMATIC WITHDRAWAL FROM A CHECKING OR SAVINGS ACCOUNT. NO MONTHLY CHECKS OR CASH WILL BE ACCEPTED. -ALL MEMBERSHIPS AND PASSES ARE NON-REFUNDABLE AND NON-TRANSFERABLE. -IF AUTOMATIC WITHDRAWAL IS DISCONTINUED AT ANY TIME DURING THE INITIAL 12 MONTH PERIOD, THE REMAINING AMOUNT ON THE INITIAL 12 MONTH MEMBERSHIP WILL BE DUE IMMEDIATELY. -FOLLOWING THE INITIAL 12 MONTH PERIOD, YOUR MEMBERSHIP WILL BE CONTINUED ON A MONTHLY BASIS. -TO STOP AUTOMATIC WITHDRAWALS AND CANCEL YOUR MEMBERSHIP FOLLOWING YOUR INITIAL 12 MONTHS, THE AQUATIC CENTER MUST BE NOTIFIED, IN WRITING, 30 DAYS PRIOR TO YOUR AUTOMATIC WITHDRAWAL DATE. -IF NOTIFCATION IS NOT RECEIVED THE AQUATIC CENTER WILL CONTINUE YOUR AUTOMATIC WITHDRAWALS AND MEMBERSHIP.I wish to purchase *Paid In Full Annual MembershipQuarter Pass6-Month PassAnnual Member Benefits: $10 off regular swim lessons, $10 off Party Room Rental or Private Parties, 5 free guest passes per year. Other discounts may be available for special events. A Quarter/6 month pass only entitles you to general use of facility during scheduled hours. It does not have the same benefits or discounts as an annual membership.Paid in Full Annual Membership *Family - $ 571.32Family-Military Corporate - $ 521.64Single Child 4-7 - $ 211.14Single Child 4-7-Military Corporate - $ 186.30Single Youth 8-11 - $ 260.82Single Youth 8-11-Military Corporate - $ 235.98Single Student 12-18 - $ 285.66Single Student 12-18-Military Corporate - $ 260.82Adult Single 19-59 - $ 310.50Adult Single 19-59-Military Corporate - $ 285.66Adult Couple - $ 422.28Adult Couple-Military Corporate - $ 372.60Golden Single - $ 260.82Golden Single-Military Corporate - $ 235.98Golden Couple - $ 310.50Golden Couple-Military Corporate - $ 285.66A 3.5% service charge is added to each online purchase.Customer Copy- Annual Membership ContractGuideline Information: • ALL MEMBERSHIPS AND PASSES ARE NON-REFUNDABLE AND NON- TRANSFERABLE • Operating hours are established by the Worland Aquatic Center staff and are subject to change. • As an open aquatic center, all areas of the pool may not always be available at all times. • No pass extensions or partial refunds will be given due to closures. • Pass holders damaging Worland Aquatic Center equipment will be subject to replacing the item at the Aquatic Center’s cost. • All children under 8 years of age MUST be accompanied by a responsible adult over the age of 18. • Children 4 and under MUST have an adult in the water with them at ALL times. • Lifejackets are available. Please use correct size for your child. (not allowed in 7ft or deeper) • Children under 5 are not allowed in the hot tub. • Children under 12 must be supervised by an adult in the hot tub. Please read posted rules. • Patrons found in violation of any of the rules posted or otherwise stated by staff employees for the areas in the facility may be asked to leave the center and may have their privileges revoked. Reminders: • Please read rules posted around the pool. They are for your safety and others. No street shoes on deck. Water only- No food, drinks, or gum on deck. Children must be 48” tall without shoes to go down the slide. Toys are available for use located behind the lifeguard chair. Please return when done.Monthly Payments Annual Membership *Family - $ 47.61Family-Military Corporate - $ 43.47Single Child 4-7 - $ 17.60Single Child 4-7-Military Corporate - $ 15.52Single Child 8-11 - $ 21.74Single Child 8-11-Military Corporate - $ 19.66Single Student 12-18 - $ 23.80Single Student 12-18-Military Corporate - $ 21.74Adult Single 19-59 - $ 25.88Adult Single 19-59-Military Corporate - $ 23.80Adult Couple - $ 35.19Adult Couple-Military Corporate - $ 31.05Golden Single - $ 21.74Golden Single-Military Corporate - $ 19.66Golden Couple - $ 25.88Golden Couple-Military Corporate - $ 23.80Quarter Pass *Family - $ 232.88Single Child 4-7 - $ 76.59Single Child 8-11 - $ 101.43Single Student 12-18 - $ 113.85Adult Single 19-59 - $ 126.27Adult Couple - $ 155.25Golden Single - $ 93.15Golden Couple - $ 113.856 Month Pass *Family - $ 310.50Single Child 4-7 - $ 115.92Single Youth 8-11 - $ 140.76Single Student 12-18 - $ 153.18Adult Single 19-59 - $ 181.12Adult Couple - $ 232.88Golden Single - $ 155.25Golden Couple - $ 181.12End Date for Initial 12 Month ContractTotal$ 0.00Square *CardName on CardSubmit
