Antiquity Homeowner's Association

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                    Antiquity Homeowner’s Association
                             2011 Pool Party Private Use Reservation Form

The following must be submitted to the Antiquity Pool Committee two weeks prior to your event by
emailing this form to:
     Pool Party Private Use Reservation Form
     $250.00 deposit (payable to Antiquity HOA)
     $25.00 fee per hour for a lifeguard. (Check made payable to Charlotte Swim Club Management)
        Hawthorne Management Co., PO Box 11906, Charlotte, NC 28220-1906, phone: 704-377-0114

Date of Event: ___________________________                   Time:

Resident Name: _________________________________             Email:


Home Phone: ___________________________________              Cell:

Number of Attendees:_______________________                  Age Group: ________________________

     Lifeguards are required at ALL private parties regardless of pool usage.
     $25.00 per lifeguard per hour (include ½ hour after scheduled party)
     One chaperone required for every 10 guests under the age of 18. Chaperones are expected to
        provide constant supervision and added support to the lifeguard staff during the party.
     Any resident hosting a private party or event may NOT have any more than 15 non-resident

        Lifeguard Fee Calculation (check payable to Charlotte Swim Club Management):
                                  Length of party (add ½ hour and after event) ________.5____
                                                             # of Lifeguards ______________
                                                             # of Chaperones ______________
                                                    $25.00 per hour for lifeguard     ______________
                                                     Total Lifeguard Payment ______________

All parties and/or events are required to use ONLY CSCM lifeguards. For insurance and liability reasons,
there can be NO exceptions to the above policies! This form must be completed and returned to the
Antiquity Pool Committee by emailing: Deposit check can be dropped off to a
pool committee member. Lifeguard fees can be mailed to: Antiquity HOA, (Attention HOA Manager) PO
Box 11906, Charlotte, NC 28220.

I have read and agree to abide by all the 2011 Pool Rules for Antiquity Homeowner’s Association.

Signature: _______________________________          Date: ___________________________

Company Use:     Date Received: _____________       Payment Received: Yes_____        No_____

Amount of Payment: ___________ Name of Lifeguard Rec. Payment: ____________

            P.O. Box 11906 Charlotte, NC 28220 (704) 377-0114           Fax (704) 347-4475

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