2017 Copperfield Swim & Racquet Club Application

Lot Number
Last Name
First Name
Address
E-mail
Phone

Spouse

Please list all permanent Copperfield residents of all ages. (Including children under 11 that do not need cards.)

Child Birth Date
Child Birth Date
Child Birth Date
Child Birth Date

Season Pass ($25/year required)
Babysitter
Grandchild
Babysitter/Grandchild Address

Access to the pool is by a validated membership card only. All those 11 years old and older are required to have a Copperfield membership card.

Resident children younger than 11 years do NOT need a membership card but must be in the care of a member 15 years old or older.

Cards will be checked by gatekeeper, please be sure each member of your family has your pool card at all times. NO EXCEPTIONS.

Membership cards are validated free of charge every year through 2017. Do not discard your membership card.

Your first card is free. Each replacement card costs $25.00. Select the appropriate choice above. (New, Sticker Only, Replace)

Validation stickers/cards will be mailed to you if the following conditions are met:

  • All fees (late fees, replacement costs) must be paid before cards or validation stickers will be sent.
  • Homeowners Association dues and any other fees must be current to use the facilities.
  • Application and fees must be received no later than APRIL 5 to avoid late fee. Applications received after APRIL 5 must be submitted with a $40 late fee.
  • Every homeowner must fill out this form completely every year to get access to the pool.

Please make check payable to Copperfield Homeowners Association.

Emergency Contact
In the case that your child(ren) needs assistance and you cannot be reached, whom can we contact?
Name Phone

The undersigned agrees to conform to and be bound by the rules and regulations of the Copperfield Swim and Racquet Club. In case of illness or injury to myself or my child(ren), I hereby give consent to the pool management company to obtain and provide medical treatment and services as are deemed necessary.

Check here to acknowledge consent Date

In order to receive your pool membership sticker/card, this form must be returned by APRIL 5 to avoid $40 late fee, and a check mailed to:
Copperfield Homeowners Association
P.O. Box 43147
Louisville, KY 40253

EVERY RESIDENT MUST FILL THIS OUT EVERY YEAR TO RECEIVE A VALIDATION STICKER OR MEMBERSHIP CARD