Key West Swim And Tennis Club
2017 Membership Application Packet
Member Last Name _____________
Thank you for waiting patiently; we’re ready to go now! This packet contains everything you
need to set up your Key West Club membership; if you have any questions, or if you know
any potential new members whom we should contact, please tell Claire at
[email protected] or 434.977.8536.
Located in the Key West neighborhood, the KWC accepts members from the general public.
We are a private swim and tennis club; our 40-acre facility includes two asphalt tennis courts,
a lifeguarded 25-meter swimming pool with diving well and board, a separate toddler pool, a
large concrete apron and raised wooden deck with lounge chairs and tables, gas grills, and a
sheltered area with restrooms, snack bar, and game tables. We offer Babysitter Passes (no
charge), Houseguest Passes (small fee), and Deck Rentals (reasonable fee) for members;
members also enjoy reduced rates for participation in the KWC Swim and Tennis teams.
The swim and tennis facilities are available from Memorial Day through Labor Day. Yearround, however, members can walk the wooded trails that run alongside the Rivanna River,
including a river beach suitable for putting in kayaks and canoes.
After two years without a rate increase, this year the Board voted to raise membership rates
by approximately 3%. We know our members understand that we are able to remain a very
good value relative to the other private swim/tennis clubs in the area because the amount of
(mostly volunteer) labor that goes into maintaining the facility; we also take seriously our
responsibility to invest in the property and keep adequate funds on hand for emergencies
and upcoming major projects.
We will kick off the 2017 season on Memorial Day weekend (May 27, 28, 29 from noon until
8 p.m.). This will be an Open House weekend, so bring your non-member friends to see
what a great community we have! If any of them join, you could be eligible for our Member
Referral Rebate: current members who refer a new member to join will receive 10% off
their membership in the form of a rebate at the end of the season, and 5% off for
each additional referral! Please ask your referrals to indicate your name on their
Membership Request Form, or email Claire at [email protected].
We hope to receive your membership materials and fee no later than 5/31/17. If you are
ready to submit your 2017 Membership Application, you will find everything you need in
this packet: a Membership Request Form; a Membership Family & Emergency Contact
Information Form; and a copy of the Key West Club Rules. Please read through the rules
and sign the waiver before sending your completed membership forms and payment (check
payable to Key West Club) to
ATTN: Membership Coordinator
Key West Club
393 Key West Road
Charlottesville, VA 22911
Key West Swim And Tennis Club
2017 Membership Application Packet
Member Last Name _____________
___ This is a NEW MEMBERSHIP application (if referred by a current member, please
provide the current member’s name: __________________________________________)
___ This is a MEMBERSHIP RENEWAL application.
Family Name (the name to be associated with
Contact Phone Number(s)
the membership, as in Jones, Jones-Harris, etc.)
Mailing Address
Email Address
Full-Access Membership Categories
Fee (Rec’d Before
5/31/17)*
Dual-Headed Family: two adults heading a household with
dependent children at home
Single-Headed Family: one adult heading a household with
dependent children at home
Couple: adult couple with no dependent children over the age of
one at home
Senior Couple: at least one member of couple over 62
Single: member over 21
Single Senior: member over 62
Teen Membership: teens (13-18) who are registered for KWC
Swim or Tennis Team; access to all facilities but no guest
privileges.
Limited-Access Membership Categories
Land Use Membership: gives all members of a household access
to trails & river beach for water access; use of tennis, pool, &
garden facilities is not included.
Add $35 late fee if past 5/31/17
$595
Full-access memberships provide access to the trails, river, and garden facilities
as well as the pool and tennis courts.
Optional contribution to the KWC Scholarship Fund (see below)
$465
$360
$265
$235
$195
$150
$100
$35
1
TOTAL AMOUNT 
Make checks payable to Key West Club and mail to ATTN: Membership Coordinator, 393
Key West Drive, Charlottesville, VA 22911.
Our 2017 pre-season Work Party dates are set! We need HELP to get the facility ready;
please indicate which Work Party you can attend, and you’ll get a 10-punch Guest Pass
good for the 2017 season! (You can attend more than one Work Party, but we award only
one Guest Pass per member family.)
____
____
____
April 23, 2-5 pm
May 7, 2-5 pm
May 21, 2-5 pm
Contributions to this fund will be reserved to provide need-based support for membership, swim
team, or tennis team at the Board’s discretion.
1
Key West Swim And Tennis Club
2017 Membership Application Packet
Member Last Name _____________
Key West Swim And Tennis Club
2017 Membership Application Packet
Member Last Name _____________
FAMILY NAME: _____________________________________________
If you are a returning member and none of your contact info has changed, simply fill out the family name and
we will use your contact info from last year. We MUST have you sign the waiver on the back of the
page, though!
INDIVIDUAL MEMBER INFORMATION
The following information is required for EACH member of the family who will have access
to the facility.
Member #1 Full name:
Known Medical Conditions (including allergies):
Member #2 Full name:
Known Medical Conditions (including allergies):
Member #3 Full name:
Known Medical Conditions (including allergies):
Member #4 Full name:
Known Medical Conditions (including allergies):
Member #5 Full name:
Known Medical Conditions (including allergies):
Member #6 Full name:
Known Medical Conditions (including allergies): Please use the back of this page to list additional
members.
Key West Swim And Tennis Club
2017 Membership Application Packet
Member Last Name _____________
EMERGENCY CONTACT INFORMATION
Please provide the name(s) of up to 3 persons who can be contacted in an emergency.
Emergency Contact #1
Full name:
Relationship to Member Family:
Phone Numbers (indicate home, work, or cell):
Emergency Contact #2
Full name:
Relationship to Member Family:
Phone Numbers (indicate home, work, or cell):
Emergency Contact #3
Full name:
Relationship to Member Family:
Phone Numbers (indicate home, work, or cell):
By my signature below, I certify that…
…if a medical emergency occurs and none of the above-named people can be contacted, the staff
of the KWC has permission to seek emergency treatment at the nearest hospital;
…the Member information above provided is true and accurate;
…I have been provided a copy of the KWC Rules, and my family understands and agrees to the
terms described therein, including the following Indemnification/Waiver of Liability/Deemed
Consent:
Acceptance of my MEMBERSHIP into Key West Club, hereinafter referred to as KWC, is without
assumption of responsibility of any kind by KWC, its Employee(s), Committee(s), and its Board
of Directors and Officers, or the Management of any event in which I/we may be entered or may
participate. In consideration of the acceptance of my MEMBERSHIP, I do hereby, for, and on
behalf of, myself and my heirs and legal representatives, release and forever discharge KWC, its
officers and management, and their successors and assigns, from any and all claims and
demands of every kind, nature and character which I may have or hereafter acquire for any and
all damages, losses, or injuries which may be suffered or sustained by me or my family or heirs,
in connection with my activities during the period for which MEMBERSHIP is granted, and all
such claims are hereby waived and released, and I covenant not to sue therefore. I understand
and acknowledge that the Baby Pool and Hot Tub are NEVER monitored by a lifeguard, and
children MUST ALWAYS be DIRECTLY supervised by an adult. The PRIMARY responsibility for
the Health and Safety of myself, and those in my care, is solely mine. Notice of Deemed
Consent to HIV and Hepatitis Testing: I acknowledge that I have been informed that, in the
event that a Member or employee is exposed to my (or family members’ or guests’) body fluids
in a manner which may transmit a blood borne disease, I (we) will be deemed to have consented
to testing for such diseases and to the release or disclosure of the test results to that club
member, employee, or appropriate medical professional. In the event I, or anyone associated
with my Membership, brings a Guest to KWC, I will inform them, prior to their use of the
facility, that they are bound by the Rules, Indemnification, Waiver of Liability, and Deemed
Consent.
_________________________________________________________________
_______________________
Key West Swim And Tennis Club
2017 Membership Application Packet
Member Signature
Member Last Name _____________
Date