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2. **Before filling out this application, please first CALL THE BLUFFTON PARKS AND RECREATION OFFICE AT 260-824-6069 to ensure your requested date is available**

4. Requested Date of Pool Rental:*
   Requested Date of Pool Rental:
6. Person Responsible for Rental:*
7. Phone Number:*
9. Organization Reserving the Rental (if applicable):
10. Email:*
12. Address:*
14. Pavilion Arrival Time:*
15. Swim Times:*
16. Expected Number of Guests:*
18. Requested Facilities and Equipment:*

    1. Pool Party: 1 to 150 guests, MONDAY through THURSDAY ($125 per hour)
    2. Pool Party: 1 to 150 guests, FRIDAY through SUNDAY ($145 per hour)
    3. Pool Party: 151+ guests, MONDAY through THURSDAY ($175 per hour)
    4. Pool Party: 151+ guests, FRIDAY through SUNDAY ($195 per hour)
    5. Pavilion only ($48.15 per day; free with pool party rental)
    6. Logrolling ($20 per hour)

22. Wells Community Pool Rules

    Pool Phone: 260-824-1550  ;  Parks & Recreation Office: 260-824-6069

    • By State Law, a soap shower is required before entering the pool and after using the restrooms.
    • Small children must use swim diapers.
    • Persons with open sores, rashes, or diarrhea are not allowed in the facility.
    • No pushing, running, rough play, or horse-and-rider in the pool area
    • No alcoholic beverages, illegal drugs, firearms, or any other weapons are permitted.
    • No coolers or glass articles of any kind are allowed in the pool area.
    • State laws (Sec 5, 410 IAC 6-2-5) prohibit consuming food on the pool deck.
    • No profanity, improper behavior or attire, intoxication, or vulgar remarks.
    • No spitting, spouting water, nose-blowing, or discharging body waste in the pool.
    • All items brought into the pool facility may be searched at any time by staff or Bluffton Police.
    • No tennis balls, squirt guns, or pets are allowed in the facility.
    • No hanging or playing on the ropes, lane lines, or guard chairs/stands.
    • The distraction of the lifeguards will not be tolerated.
    • If you are asked to leave, NO refunds will be given.
    • The facility is subject to closure at the discretion of the pool manager.

    Guardians are responsible for supervising their children; lifeguards are responsible for responding to emergencies. Follow the direction of the lifeguards at all times.

    Diving Area Rules

    • A swimming test may be required before being allowed in the diving well.
    • Diving is permitted from the diving boards only.
    • Dive straight off the board and swim directly to the ladder closest to you.
    • Jumping toward the side of the pool will not be tolerated. You must use the ladder when leaving the water in the diving area.
    • Only one person on the board at a time and only one waiting on the ladder at a time is allowed. Only one bounce on the diving board is permitted.
    • No Balls, Frisbees, or any other toys are allowed in the diving area.

    Slide Rules

    • Riders must be at least 42” tall to ride the big slide. (NO EXCEPTIONS)
    • No life jackets or any other floating devices are allowed.
    • You must be able to swim comfortably in the depth of water at the bottom of the slides.
    • Only one rider at a time. (NO EXCEPTIONS)
    • No running, standing, kneeling, rotating, tumbling, or stopping while on the slide.
    • You must ride feet first, flat on your back, with ankles and arms crossed. This is for your safety.
    • Move quickly from the roped area after the ride.
    • No cut-off shorts or any swimming attire with rivets, buttons, or fasteners are allowed on slides.
    • Only one person per step on the slides.
    • No pushing or shoving.
    • No Balls, Frisbees, or any other toys or riding devices are allowed on slides.

    
    

26. RELEASE AND INDEMNIFICATION AGREEMENT

    In consideration for the privilege of renting for private use the Wells Community Pool, I, the undersigned (on behalf of the organization for which I am executing this Waiver), HEREBY WAIVE, RELEASE, AND DISCHARGE the City of Bluffton, the Bluffton Department of Parks and Recreation, the Mayor of Bluffton, the Common Council of the City of Bluffton, the Bluffton Board of Public Works and Safety, and any agents, successors, assigns or employees of any of the foregoing from any and all claims or liabilities for death, personal injury, property damage, or damages of any kind whether or not attributable to the negligence of the releases as indicated above, which arise out of the rental and use of the facility by my organization or me on the rental date.

    I AND/OR THE ORGANIZATION HEREBY AGREE NOT TO SUE any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released, or discharged herein.

    I AND/OR THE ORGANIZATION HEREBY AGREES TO INDEMNIFY AND HOLD HARMLESS any person or entity identified above from any claims for damages or injuries asserted by others who may use the facility during the course of our renting of it, including but not limited to members of my family, employees, invitees, guests, members of the organization on behalf of which I am executing this release, and their families, friends, and guests, and any and all others who may use the facility I (we) are renting or using the facility.

    The Organization shall be responsible for transporting the standard to their intended place of use and returning them to their original location thereafter. A standard rental fee has been paid to the City of Bluffton for the rental, but this Release and Indemnification Agreement is given as a material inducement to the City to enter into the rental agreement and is an essential and integral component of said Agreement.

    I HEREBY AFFIRM that I am 18 years of age or older, that I have read and understood the foregoing, and that I am authorized to execute this instrument on behalf of the Organization.

28. Date Submitted:*
    Date Submitted:
29. Electronic Signature:*
33. Information Consent:*

    1. I consent to the City of Bluffton, Indiana storing my submitted information so they can respond to my inquiry.
Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

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