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2013 POLL PASS RATES & APPLICATION

2013 POOL PASS RATES AND APPLICATION
Tel. # (508) 886-0048


type of pass
until May 1st
starting May 1st

family resident (up to 4) season pass*
150
160
family non-resident season pass**
175
185
individual resident day pass
n/a
$5
individual non-resident day pass
n/a
$10
resident 10-pass punch card
n/a
$45
non-resident 10-pass punch card
n/a
$90
*$10 each additional family member (capped at $210 per family)
**$10 each additional family member (capped at $225 per family)
ALL MEMBERS ON A FAMILY PASS MUST RESIDE AT THE SAME ADDRESS. CHILDREN UNDER 14 MUST BE SUPERVISED AT ALL TIMES.
PASSES ARE NOT TRANSFERABLE.

applicant name
applicant address
applicant city/state/zip
applicant home phone
applicant cell/work phone
MEMBERS OF HOUSEHOLD:

name
   age
  pool pass #
1.
2.
3.
4.
5.
6.
I have read the pool guidelines and free to follow all pool rules.  Failure to do so will result in pass suspension.
Signature _________________________________________________Date:____________________________
        CHECK #: ________________       CASH: _________

‚ÄúThis Institution is an equal opportunity provider.  To file a complaint of discrimination
write USDA, Director, Office of Civil Rights, Washington, DC 20250-9410



 
Town of Rutland 250 Main Street, Rutland, MA 01543   Disclaimer
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