Union Park - Amenity Access Card Registration

Name Name First Last
DOB (If under 18) DOB (If under 18) / MM / DD YYYY
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Mobile Phone Mobile Phone - ### - ### ####
Email
New Resident Verification Documents

The amenities in the community are restricted to the residents of the district. Proof of ID and Proof of Occupancy (Ownership) is required for all new registration applications.
Upload a file to verify your identity (driver's license, state-issued photo ID, military ID):

This field is required. Please upload a file.
Upload a file to verify your occupancy status (deed, lease agreement, ownership agreement, current utility bill):

This field is required. Please upload a file.
ACCEPTANCE

I acknowledge receipt of one (1) Facility Access Card and that the above information is true and correct. I understand that I have willingly provided all the information requested above and that it may be used by the District for various purposes. I also understand that by providing this information that it may be accessed under public records laws. I also understand that I am financially responsible for any damages caused by me, my family members or my guests and the damages resulting from the loss or theft of my Facility Access Card. It is understood that Facility Access Cards are the property of the District and are non-transferable except in accordance with the District’s rules, policies and/or regulations. In consideration for the admittance of the above listed persons and their guests into the facilities owned and operated by the District, I agree to hold harmless and release the District, its agents, officers and employees from any and all liability for any injuries that might occur in conjunction with the use of any of the District’s amenity facilities (including but not limited to: swimming pools, playground equipment, other facilities), as well while on the District’s property. Nothing herein shall be considered as a waiver of the District’s sovereign immunity or limits of liability beyond any statutory limited waiver of immunity or limits of liability which may have been adopted by the Florida Legislature in Section 768.28 Florida Statutes or other statute.
Signature of Patron
(Parent or Legal Guardian if minor)
Date Date / MM / DD YYYY
RECEIPT OF DISTRICT RULES AND RATES

RECEIPT OF DISTRICT RULES AND RATES I acknowledge that I have been provided and understand the terms in the Amenity Facility Policies.
GUEST POLICY

Please refer to the Amenity Facility Policies for the most current policies regarding guests.
Are you requesting an additional card or replacement card?

Are you requesting an additional card or replacement card? Replacement Card Additional Card
Signature of Patron
(Parent or Legal Guardian if minor)
Date Date / MM / DD YYYY
Payment (please select only one option)

Payment (please select only one option) Square Automated payment (3.3% + $0.30 service charge will apply) Check/Mail (expect delays due to mail service)

How do you prefer to remit payment?
NOTE:

Upon submission AND review of this form, a confirmation email will be sent to you with payment instructions based on your preference above.
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Union Park - Amenity Access Card Registration

New Resident Verification Documents

ACCEPTANCE

GUEST POLICY

NOTE: