2012 MBWPoolPassApp Tenant

							                                                    Please Print Clearly
                                           Use this form ONLY if you rent your home

                                    Meadowbrook Woods Homeowners Association
                                                        C/O Sequoia Management Company, Inc.
                                                       13998 Parkeast Circle, Chantilly, VA 20151
                                                                Phone: (703) 803-9641
                                                                Fax: (703) 968-0936

                             The MBW owner OR the Resident may use the pool, but NOT BOTH

                                          2012 Tenant Pool Pass Application
Please complete ALL sections below. Competed application should be submitted as follows:
     Mail to MBWHOA, c/o Sequoia Management Company, 13998 Parkeast Circle, Chantilly, VA 20151-2283
         Attention: Lauren Randall or email to lrandall@sequoiamgmt.com or fax to (703) 968-0936

Section I          Tenant Information:            The below listed persons are tenants residing at the address below and as such are
                                                  authorized to obtain pool passes for Meadowbrook Woods Community Pool


    Tenant Name:
        Address:
Phone Number:
                   (Home)                                                       (Work)

                   (Email)                                                      (Work)


     Section II     Authorized Users                                   (Passes will only be issued to persons six years old as of Memorial Day)

     Names of All Persons Using a Pool Pass                        Date of Birth (Required)                 If this is a New Issue               
1
2
3
4
5
6



Section III        Emergency Contact Information
    In case of emergency contact:


    Name                                                         Phone

Section IV         Tenant Acceptance of Rules
I/We acknowledge all users listed on this application will abide by the pool rules and procedures posted on the MBW web site,
www.meadowbrookwoods.org, by the signature below. In consideration for using the Meadowbrook Woods Community Pool,
I/We agree to abide by the Association Rules and Regulations regarding the facilities therein.


    Signed                                                  Date