CITY OF GLEN DALE, 402 WHEELING AVENUE, GLEN DALE WV 26038
GLEN DALE RECREATION BOARD
POOL PASS APPLICATION
FAMILY PASS # ( )
SINGLE PASS # ( )
NAME: ____________________________________________________
ADDRESS: ________________________________________________
CITY: ________________________________WV: _________________
PHONE: ____________________________________
AUTHORIZED PASS USERS:
1. _____________________________________________________
2. _____________________________________________________
3. _____________________________________________________
4. _____________________________________________________
5. _____________________________________________________
6. _____________________________________________________
7. _____________________________________________________
The park and recreation board and the pool supervisors have the right to restrict pass holders and swimmers from engaging in conduct contrary to the rules set forth at the pool and individuals not complying may be suspended from use of the pool after proper warning. The price of the pass is not refundable.
I understand the above rules: __________________________________(Signature)
Stamp Date Paid here Amount Paid: $________________