INCORPORATED VILLAGE OF FLORAL P

INCORPORATED VILLAGE OF FLORAL PARK

2008 – 2009 LEISURE PASS APPLICATION

(FOR NON-POOL MEMBERS — LIST NAMES OF APPLICANTS ONLY)

Family Name:_____________________________________________________________________________

Address: __________________________________________________________________________________

Home Phone:_____________________________ Business Phone:________________________________

Husband’s First Name: __________________________ Wife’s First Name: _______________________

Children’s Names Date of Birth Age School

________________________ ____________ _____ ______________________

MEMBER ELIGIBILITY

All applicants must be a current resident of the Inc. Village of Floral Park. Immediate members of the family include: father, mother, school age children, and working sons / daughters 23 years of age or younger.

GUESTS

The village reserves the right to limit guests and privileges. Guests must accompany a member who presents a leisure pass upon request, at all times.

ALL APPLICATIONS MUST INCLUDE:

1) One picture ID Per Adult (18 yrs. and over) with applicant’s name.

2) One current 2008 or 2009 utility bill at current address.

3) Birth or Baptismal Certificate per child

4) One photo Per Applicant (1 1/4’’ X 1 1/4’’)

I hereby apply for a leisure pass for the Inc. Village of Floral Park Recreation Center. I agree to abide by the rules and regulations thereof and accept all conditions as stated wherein. Any falsification in the application information can result in the cancellation of the leisure pass and loss of privileges.

Signature:_________________________________ Date Submitted:____________

Recreation Center Use Only below this line:

Date Processed:_________ Signature:____________________ Leisure Pass No._________