ANABELLE ISLAND COMMUNITY DEVELOPMENT DISTRICT 
AMENITIES ACCESS REGISTRATION FORM 

NAME: 

ADDRESS: 

HOME TELEPHONE: CELL PHONE: 

EMAIL ADDRESS: 

ADDITIONAL RESIDENT 1: DOB IF UNDER 18 
ADDITIONAL RESIDENT 2: DOB IF UNDER 18 
ADDITIONAL RESIDENT 3: DOB IF UNDER 18 
ADDITIONAL RESIDENT 4: DOB IF UNDER 18 
ADDITIONAL RESIDENT 5: DOB IF UNDER 18 

ACCEPTANCE: 
I acknowledge receipt of the Access Card(s) for the above-listed residents and that the above information is true and correct. I understand 
that I have willingly provided all the information requested above and that it may be used by the Anabelle Island Community Development 
District (“District”) for various purposes. I also understand that by providing this information that it may be accessed under public 
records laws. I also understand that I am financially responsible for any damage caused by me, my family members or my guests and the 
damages resulting from the loss or theft of my or my family members’ Access Card(s). It is understood that Access Cards are the property 
of the District and are non-transferable except in accordance with the District’s rules, policies and/or regulations, and any necessary 
replacement will be at an applicable Replacement Access Card fee. In consideration for the admittance of the above listed persons and their 
guests into the facilities owned and operated by the District, I agree to hold harmless and release the District, its supervisors, agents, officers, 
professional staff and employees from any and all liability for any injuries that might occur, whether such occurrence happens wholly or in 
part by me or my family members’ or guests’ fault, in conjunction with the use of any of the District’s Amenity Facilities (as defined in the 
District’s Amenity Policies and Rates), as well while on the District’s property. Nothing herein shall be considered as a waiver of the 
District’s sovereign immunity or limits of liability beyond any statutory limited waiver of immunity or limits of liability which may have 
been adopted by the Florida Legislature in Section 768.28 Florida Statutes or other statute. 

Signature of Patron (Parent or Legal Guardian if Minor) Date 

AFFIDAVIT OF RESIDENCY: (REQUIRED IF LEGAL FORM OF PROOF OF RESIDENCY NOT PROVIDED) 

I hereby state that the address listed above is the bona fide residence for all residents listed in this Amenities Access Registration Form and 
that such address is located within the Anabelle Island Community Development District. I acknowledge that a false statement in this 
affidavit may subject me to penalties for making a false statement pursuant to Section 837.06, Florida Statutes. I declare that I have read 
the foregoing and the facts alleged are true and correct to the best of my knowledge and belief. 

Signature of Patron 
State of Florida 
County of __________________ 

The foregoing was acknowledged before me by means of . 
physical presence or . 
online notarization this ____ day of _________, 20__, 
by ____________________ who is [ ] personally known to me or [ ] produced _______________________ as identification. 

(NOTARY SEAL) __________________________________________ 
Official Notary Public Signature 



RECEIPT OF DISTRICT’S AMENITY POLICIES AND RATES: 

I acknowledge that I have been provided a copy of and understand the terms in the Amenity Policies and Rates of the Anabelle 
Island Community Development District. 

_________________________________________ ____________________ 
Signature of Patron Date 
(Parent or Legal Guardian if minor) 

GUEST POLICY: 
Please refer to the Amenity Policies and Rates for the most current policies regarding guests. 


PLEASE RETURN THIS FORM TO: 

Anabelle Island Community Development District 
c/o GOVERNMENTAL MANAGEMENT SERVICES, L.L.C. 
475 West Town Place, Suite 114 
St. Augustine, FL 32092 
Office: (904) 940-5850 x412 
Email: mgiles@gmsnf.com 


OFFICE USE ONLY: 
____________ ___________________ _________________________ 
Date Received Date Entered in System Staff Member Signature 
PRIMARY RESIDENT: Access Card # 
ADDITIONAL INFORMATION: 
Phase ___ – _____ Phase ____ – ____ Phase ____ – _____ 
New Construction: _____ Re-Sale: ______ Prior Owner: _______________________ 
Rental: _____ Landlord/Owner: ______________________________________ 
Lease Term: ________________ Tenant/Renter: _______________________________________