Please print, fill-out, and mail.
V.I.P. Country Club
600 Davenport Avenue (914) 235-1500
New Rochelle, NY 10805 Fax: (914) 235-1502
2009 MEMBERSHIP APPLICATION
I hereby make application for membership for myself and my family for the 2009 Season. If accepted, I agree to comply with all the terms, rules and conditions of the Club, both existing and hereafter adopted by the management. I further understand that the Club’s Director shall have the right at any time, and in his sole discretion, to revoke my membership and withdraw all privileges to which I shall be entitled.
Applicant's Name__________________________ Spouse (CabanaMate)________________________
Home Address____________________________ CabanaMate Address_________________________
(Street) (Street)
________________________________________ __________________________________________
(City, State, Zip) (City, State, Zip)
Home Phone _____________________________ CabanaMate Phone__________________________
Business Phone___________________________ # of Additional Parking Passes______ @ $250/pass
Children (name/age): Associates (name/address/phone):
1) ______________________________________ 1) ______________________________________
2) ______________________________________ ______________________________________
3) ______________________________________ 2) ______________________________________
4) ______________________________________ ______________________________________
I hereby waive claim for any loss or damage of automobile or other personal property or for personal injury while members at V.I.P. Country Club and with respect to any accommodations. I knowingly and freely assume all risk of personal injury and/or property damage both known and unknown, even if arising from the negligence of the V.I.P. Country Club, or others, and assume full responsibility for my participation as a member of the V.I.P. Country Club. If I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and immediately bring it to the attention of the nearest official. I, for myself and as parent/guardian with legal responsibility for my child's/children's participation, do consent and agree to his/her release on behalf of myself, my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless the V.I.P. Country Club, its officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct any event, from any and all claims, demands, losses, and liability arising out of or related to any injury I or my child/children may suffer, or loss or damage to person or property, whether arising from the negligence of the V.I.P. Country Club or otherwise, to the fullest extent permitted by law. I have read this release of liability and assumption of risk, fully understand its terms, and sign it freely and voluntarily:
Payment Schedule
I hereby agree to pay the rental fee for the accommodations as follows: A NON-REFUNDABLE deposit of $500 for each family in a cabana, junior cabana, or cabinette, is due with the application. In order to reserve your current facility for 2009, your deposit must be received by October 1, 2008. After October 1, 2008 all facilities will be assigned on a first come, first serve - paid basis. Balance is due by March 1, 2009 (a 5% finance charge will be applied on the outstanding balance after April 1, 2009). I also agree and further understand that I shall be liable for the fee for the full season and there will be NO REFUND for any reason.
If your account is paid in full by 11/30/08, you will be entitled to a 5% discount.
Signature______________________________ Date_________________ Cabana #____________
For Office Use Only: Deposit Amount $______________________ Date_______________
V.I.P. Country Club