ALEX HALEY MUNICIPAL POOL
2010 SEASON PASS APPLICATION
Good only for admission to Alex Haley Pool- ONLY
Pool passes are for sale Starting May 24 – August 27, 2010
NAME _____________________________________________
ADDRESS _________________________________________ PHONE ______________________
Primary Residence (Check one): Enter Quantity of each: Fee:
___ City of Ithaca ___ Child (0-12) $15.00
___ Town of Ithaca ___ Student/Senior Citizen $20.00
___ Town of Caroline ___ Adult (18-55) $25.00
___ Town of Danby ___ Family (1-5 members*) $55.00
___ Town of Dryden * Each additional family member is $15.00
___ Town of Enfield (i.e. family of 6 for $70.00, 7 for $85.00)
___ Town of Groton
___ Village of Lansing Scholarships are available upon request!
___ Town of Newfield
___ Town of Ulysses
Complete information for all card holders below:
Pass# Name Date of Birth Age
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Office Use ONLY:
Date of Application _________
Number of passes requested ___________ Pool pass numbers __________
Scholarship requested __________ Amount of scholarship ____________
Staff issuing pool passes ________
Please Read and Sign
I swear the information contained in my application is in all respects true,
correct and current to date. My season pass will be revoked with NO
REFUND given if any of the information given is false. I agree to abide by all
rules and regulations of the Alex Haley pool and any policies regarding the use
of a season pass.
Season Pass Policy
1. Season passes are non-transferable: if your pass is given to another individual, it is
subject to revocation. However, childcare providers will be included on family season
passes for Municipal pools, when they are acting in lieu of parents in accompanying
children to the facilities.
2. Individuals found using another individual’s pass is subject to arrest and prosecution
for “theft of services.”
3. If you forget your pass, you will be required to pay the normal rates, with NO
REFUNDS ISSUED.
4. If a pass has been lost or stolen, replacement is by the purchase of a new card for
$5.00.
5. There is No reduced rate for half season or rebate (for any reason) for unused
portion of a season pass.
6. Passes may not be purchased for more than one season.
7. All season ticket holders must register at the admissions counter each time they use
the facility.
Please note: All children who are not toilet trained are required to wear swim diapers in
the kiddy and large pool.
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Signature Date