NWHCMUD #24 Water Bill Account No:

Telephone Number

Name

Address

Zip Code

Email Address

Emergency Contact Name:

Emergency Contact Number:

RELEASE AND WAIVER OF LIABILITY

I have completed an application for use of Northwest Harris County Municipal Utility District No. 24’s (hereinafter the “District”) recreational facilities (Splash Pad and Park Area) on behalf of myself and the listed household members and our guests. I understand that the District’s recreational facilities are for use of authorized persons only, and agree that all use by me, listed household members and our guests shall be in accordance with the District’s Recreational Facilities Rules and Regulations. I agree that the District does not, by providing access to use its recreational facilities, assume any responsibility or liability to me, listed household members, or our guests. Me, listed household members, and our guests agree to indemnify and hold harmless the District, its Directors, agents, employees and consultants whether paid or volunteer, from any and all claims by us or our guests which may arise out of use of the District’s recreational facilities. If this application is on behalf of any minor children, this application represents that the applicant is the legal guardian of said children and fully responsible for such children and authorized to execute this application and release on their behalf. I understand that children, if under ten (10) years of age, must be accompanied by a person fourteen (14) years of age or older when using the District’s facilities. I further understand that I am responsible for any damage to District facilities caused by my family, my guests or myself.

I agree that I have read NWHC MUD No. 24’s Recreational Facilities Rules and Regulations.
I Agree

I agree that I have read and fully understand the above Release and Waiver of Liability.
I Agree

Name

Date

HOUSEHOLD MEMBERS: All members listed below must obtain a Recreational Facility Access Band to enter the Recreational Facilities Area. (Access Bands required for ages 3 and up).

*Please list name and date of birth for each member listed.

Recreational Facilities Access Band 2023 Season

Annual Pass (Quantity)

Guest Pass (Up to Two (2) Guest Passes permitted per household)

Day Pass

(Day passes may be obtained at the District’s Administration Building by a Resident With a valid application on file. Availability will be determined by capacity.)

*Splash Pad will be closed for the Fall/Winter Season each year, please see District Website for dates related to the 2023 season. The Board reserves the right to amend days and hours as necessary.

* Only persons with Access Bands are permitted to be in the Recreational Facilities Area.
* All Guests must be accompanied by a Household Member at all times.
* No Parties of any kind are permitted within the Recreational Facilities Area.
* No Outside Grills Permitted within the Recreational Facilities Area.