Requested Pool Party Date:       Time (2 hours):

An additional total of 1-hour for setup and cleanup can be added for $25. Any changes must be made 72 hours prior to event and are subject to additional charges. Applicant has read and agrees to abide by Brushy Creek Pool Rules and Pool Party Room Policies & Fees.
(initials)

Legal & Privacy Act:
The undersigned (the "Applicant") hereby makes application for use of the Brushy Creek Municipal Utility District Pool ("The District") on the date or dates indicated above. The applicant understands and agrees that the District does not, by the provision of the facilities, assume any responsibility or liability to the applicant, applicant's employees, guests or invitees. The applicant, on behalf of the applicant, its employees, guests and invitees, assumes all responsibility for and waives any claim for compensation for accidental injury, property damage or death resulting from the use of the facilities, and agrees to indemnify and hold harmless the District, its directors, agents, employees, and consultants, whether paid or volunteer, from any and all claims by applicant, its employees, guests or invitees, which may arise out of applicant's use of the facilities. The applicant has read and agrees to abide by the District's rules and regulations concerning use of the District Pool. Privacy Act: The District is obligated under the Texas Open Records Act to give out personal and private information on customers (Such as name, address, telephone number, social security, etc.). Under the act, this information is accessible to salesman, bill collectors, disgruntled spouses, telephone solicitors, junk mail listing or anyone else that may want to know about you and your account. If you DO NOT want any information given out regarding you or your account, please initial below.
I (we) request that under the Privacy Act, the District not release any information: Initials:

Signature: Date:

Notes: