Amenity Access Request Form

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Please complete all fields on this form through the e-Mail address field to receive your amenity pass. All other fields will be completed at the management office at time of pick up. Please allow 24-48 hours for processing. Two passes per family will be given. Lost passes will be charged per the Board’s requirements. After completing the form, please update any information in the address book. Amenity Rules – https://mirrorlakehoa.net/amenities/ YOUR ACCOUNT MUST BE IN GOOD STANDING WITH THE ASSOCIATION. CHILDREN UNDER AGE 16 MUST BE ACCOMPANIED BY A PARENT OR AN ADULT, 21 YEARS OR OLDER. ONCE ADMITTED TO THE AMENITY AREAS, BEARER OF CARD ACCESS AGREES TO ABIDE BY ALL POOL RULES, TENNIS COURT RULES AND BASKETBALL RULES AND UNDERSTANDS THAT VIOLATION OF RULES WILL RESULT IN EJECTION FROM THE AMENITY AREAS AND/OR COMPLETE LOSS OF FURTHER ENTRY PRIVILEGES.

Homeowner Name*
First Last
Address
Street Address Address Line 2 City State ZIP Code
Rent/Lease
Phone
Email
Website
Consent*
I agree to ALL the Amenity Rules & Regulations.
Office Use Only
Homeowner Signature
Account Balance
Office Initials
Activation Date
MM slash DD slash YYYY
De-Activation Date
MM slash DD slash YYYY
Pick-up Date
MM slash DD slash YYYY
Reason
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Amenity Access Request Form

Office Use Only

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