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2. SEASON POOL PASS APPLICATION 

   FAIRBURY WATERPARK

4. Pass #:

   Office use Only

5. Paid by: Cash, Check # __________, Card

   *Pay at City Office or at City Pool upon opening*

7. Name:
8. Date of Birth:
9. Age:
11. Name:
12. Date of Birth:
13. Age:
15. Name:
16. Date of Birth:
17. Age:
19. Name:
20. Date of Birth:
21. Age:
23. Name:
24. Date of Birth:
25. Age:
27. Name:
28. Date of Birth:
29. Age:
31. Name:
32. Date of Birth:
33. Age:
35. Name:
36. Date of Birth:
37. Age:

39. Emergency Contacts:

41. Contact #1 Name:
42. Phone Number(s):
44. Contact #2 Name:
45. Phone Number(s):
47. Additional Information:

    Incase of emergency, please list any special medications, medical or physical needs:

49. Pool Pass Selection

    1. Individual - $75.00
    2. Family (2-4) - $125.00
    3. Family (5-8) - $200.00
    4. Ten Punch - $40.00
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

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