Required fields are marked with asterisks (*)

Lions Pool Social Agency Pass Request

The City of Stratford Community Services Department is pleased to offer social service agencies free Lions Pool swim passes for children (2-15 years) using agency services, and who are residents of the City of Stratford. Participants who are not residents of the City of Stratford are not eligible to participate in this program.

To participate in our program, please fully complete the pass request form below. To avoid duplication of requests, please communicate with your participants that they MUST ONLY use one agency to make pass requests. Abuse of this policy will result in passes being revoked.

Important Swim Policies and Procedures

We have a few important policies and procedures your clients should know before arriving at the facility. Please click here to read our swim admission policies and procedures, and share with your client guardians.

A: AGENCY DETAILS

Agency Name

Agency Contact

Email Address

Phone Number (xxx-xxx-xxxx)

Address (Street # and Name, City)

Province

Postal Code

B: PARTICIPANT DETAILS

Child #1 Name

Child #1 Date of Birth (MM/DD/YEAR)

Parent/Guardian Name of Child #1

Parent/Guardian Phone Number of Child #1 (xxx-xxx-xxxx)

* If not adding a second participant request, please skip to Section C: Review.

Child #2 Name

Child #2 Date of Birth (MM/DD/YEAR)

Parent/Guardian Name of Child #2

Parent/Guardian Phone Number of Child #2 (xxx-xxx-xxxx)

C: REVIEW

Are all participants residents of the City of Stratford?

Yes

We ask that agencies allow us at least three business days to review pass requests. Approved participants will be notified via an email to the social service agency representative when he/she can start to attend family swims. No cards will be issued as participant names will simply be registered in our electronic system, with the participant identifying themselves at the front gates when they wish to swim.

Should a participant not be approved for a social service agency pass, the City of Stratford will also notify the requesting agency within three business days.

Please note that swim passes are NOT transferable to any other persons.

I confirm that my application responses are true and accurate, and that I have read and understand the conditions to which Lions Pool Social Agency Passes are approved and delivered.

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