Registration Packet


Membership Dues Payments

RENEWAL payments are due no later than June 1, 2024
NEW REGISTRATION payments are due no later than June 1, 2024 or the member’s FIRST SWIM DAY at the club, whichever comes first.

Installment payments will be accepted. Use the PAY DEPOSIT button on the website or send your check/money order "1 of 3.” Access to the pool and grounds may be limited until dues are paid in full.

Family/Individual Information

HEAD OF HOUSEHOLD - Defined as the parent(s)/legal guardian(s) of children and/adults residing in their home.

DEPENDENTS - Defined as (a) children are under age 18. (b) children ages 18-24 actively enrolled in high school, college, or a training program; or (c) adults who are unable to work due to age or disability who reside full time in your home.



Head of Household Verification Release (REQUIRED) - By my signature below, I authorize verification of the information provided on this application form.

Medical Release Waiver (REQUIRED) - I certify that I am the parent/legal guardian of all dependent(s) listed on this ion for any supervisor or administrator associated with Urbanna Swim
Club to seek and give appropriate medical attention to my dependent(s) in the event of accident, injury, or illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment. I hereby waive, release and forever discharge Urbanna Swim Club from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Urbanna Swim Club, whether or not damages or loss is due to negligence. I hereby acknowledge that I and/or my dependent(s) am/are physically fit and capable of participation in all swim activities.

Liability Waiver (REQUIRED) – By registering myself and/or my dependent(s) listed on this application with Urbanna Swim Club I agree to participate (with my dependent(s), if applicable) with Urbanna Swim Club, and hereby release Urbanna Swim Club, its officers, board of directors, employees, and affiliated coaches from liability for any injury that might occur to me (and my dependent(s), if applicable) while participating at Urbanna Swim Club.  I agree to indemnify and hold harmless the above-mentioned organization and/or individuals, their agents and/or employees, against any and all liability for personal injury, including injuries resulting in death to me (and/or my dependent(s) or personal guests, if applicable), or damage to my property

Grounds & Water Safety Rules (REQUIRED) – I agree that I have received, reviewed, and will abide by the Urbanna Swim Club Grounds & Water Safety Rules while on Urbanna Swim Club property. I agree that I and all eligible members of my household (a.k.a. my dependent(s)) listed herein will abide by the aforementioned rules. I also certify that I will inform any invited guests of the rules and hold them responsible for abiding by the rules. I understand that violation of any of these rules are subject to consequences voted upon by the Urbanna Swim Club Board Members.

A copy of the Urbanna Swim Club Pool & Water Safety Rules is included in this membership registration package. Please print and share with your dependent(s) and/or guest(s). The rules are also posted on club property and will be enforced by all Urbanna Swim Club officers, board of directors, employees, and affiliated coaches.



Urbanna lifeguards and the pool manager have the authority to deprive any member or guest from using the grounds and pool for cause. A written statement will be filed with the Board of Directors.




1.  Members must sign in at the front desk upon entering Urbanna Swim Club grounds. Record your membership number, last name, and the number of people entering with you (swimmers and non-swimmers).

2.  Guests of members (aka sponsored guests) must also sign in and pay the guest admission fee (swimmers and non-swimmers). Members are responsible for the conduct of their guests. Any damages to the grounds, equipment, or pool will be charged to the sponsoring member. The Board of Directors will determine the amount to be charged.

3.  All patrons, members, and non-members, using the grounds and pool do so at their own risk. Neither Urbanna Swim Club nor its officers, board of directors, employees, and/or affiliated coaches shall be held responsible for any accident or injury incurred at Urbanna Swim Club.







1.  In the event of extreme weather or other emergencies, the pool and grounds will be evacuated. This includes rain heavy enough to obstruct the lifeguards’ view of the bottom of the pool, and electrical storms.

2.  Any activity that causes an undue disturbance or endangers others (running, pushing, roughhousing, or wrestling) is prohibited, in the pool and on the grounds.

3.  Foul or vulgar language, music, and/or actions are not permitted. Those engaging in such will be given a warning and/or be asked to leave. Urbanna is a family establishment; we reserve the right to protect our members’ rights.

4.  Only adults may use the grills. Children must keep a safe distance from the grills at all times. Charcoal will be provided by Urbanna on weekends and holidays. On weekdays members may purchase charcoal from the guard desk or bring their own.

5.  Alcoholic beverages are permitted for members and guests who are over the age of 21. However, any member or guest who has consumed too much alcohol may be asked to leave the grounds.

6.  All trash must be placed in trash containers. It is the members’ responsibility to clean up after themselves.

7.  Play equipment (pool noodles, dive rings, basketballs, etc.) is available at the guard desk and will be distributed at the guards’ discretion. It is the (adult) members’ responsibility to return the equipment at the end of use by their children.




1.  The baby pool is intended only for children under the age of six (6). A parent, other responsible adult, or teen (16 or older) MUST be present with their child(ren) WITHIN the fence at all times.

2.  Children under the age of eight (8) may swim in the shallow end of the pool (2-5 feet) with a parent, other responsible adult, or teen (16 or older) present at the side of the pool.

3.  No child under the age of 12 may be at the pool and/or swim without a parent, other responsible adult, or teen (16 or older) present.

4.  No child under the age of eight (8) will be allowed to swim in the deep end of the pool OR to use the diving board unless he/she has PASSED a swim test administered by an Urbanna lifeguard. This test must be passed every year at the discretion of the lifeguards and/or the pool manager.

5.  Teens age 15 and older are eligible to become a lifeguard at Urbanna. American Red Cross certification is required. Contact Donna Garzione for more information: [email protected] or (571) 224-7658.

6.  Teens over the age of 16 may swim during breaks.

Share these rules with your dependent(s) and/or guest(s). They are also posted on club property and will be enforced by all Urbanna Swim Club officers, board of directors, employees, and affiliated coaches.




The lifeguard administered swim test requires that the child demonstrate the ability to swim the length of the pool independently, with the rope in place as they enter the deep end. The child must then successfully tread water for one minute in the deep end. Tests are only given during breaks. Make arrangements for testing at the guard desk.




7.  All patrons MUST shower before entering the pool. This is a significant as excess sunblock and lotions can come off while swimming and cloud the water, preventing lifeguards from seeing the bottom of the pool.

8.  Only appropriate bathing attire (suits and trunks designed for swimming) is allowed to be worn in the pool.  Shorts, jeans, and other cut-offs are prohibited for all patrons; for female patrons, tank tops, t-shirts, and other women’s undergarments not designed as swimwear are prohibited.

9.  Regular diapers are prohibited in the pool. Children who are not yet toilet trained must wear swim diapers.  IMPORTANT: If you observe that a child has soiled their swim diaper while in either the main pool or baby pool, evacuate the area immediately and notify a lifeguard or the pool manager. Excrement in the pool is a serious health hazard.

10.  Floats and rafts are NOT allowed in the pool as they obstruct the lifeguard’s view of the bottom of the pool.

11.  Age-appropriate flotation devices for infants are allowed only if a parent or other responsible adult is with the child while in the water.

12.  Similarly, small children using water wings or age-appropriate floatation vests may swim in the 3-5 feet sections of the pool only if with a parent or other responsible adult. Otherwise, they must stay in the 2-feet area.

13.  Diving is not allowed in the shallow end of the pool (3-5 feet). Follow the signs posted around the pool.

14.  Only one person is permitted on the diving board at a time. Divers may bounce only once before entering the pool. Upon surfacing, divers must immediately swim to the closest ladder and exit the water. Only when the diver reaches the ladder may the next diver make their entry.

15.  Mandatory 15-minute breaks for children under the age of 15 will be enforced every hour on weekdays. A 20-minute break at the end of every hour will be enforced on weekends and holidays.


Share these rules with your dependent(s) and/or guest(s). They are also posted on club property and will be enforced by all Urbanna Swim Club officers, board of directors, employees, and affiliated coaches.