Domestic Helper Pass Application• Only Primary Members and Spouse Members are able to apply for a Domestic Helper Pass.
• In applying for a Domestic Helper Pass, the sponsoring Member agrees to the terms and conditions of theDomestic Helper Pass program and acknowledges and agrees to liability for the conduct of the pass holder.
• The Member, either Primary or Spouse, is required to complete an orientation session. The session should be prior
to any application for a Domestic Helper Pass.
• A copy of the domestic helper’s valid passport and visa or ID must be submitted with the application.
• I would like to apply for

one-day pass (¥1,000)

Monthly (¥6,000) Annual Renewal

Domestic Helper Pass Applicant
Name:

Date of birth:

Cell:

Sex:

MaleFemale

I hereby affirm the above details are correct and agree to abide by the terms and conditions of the Domestic Helper
Pass program.
Signature:

Date:

Names(s) of Children
Name:

Age:

Name:

Age:

Name:

Age:

Name:

Age:

I hereby request a Domestic Helper Pass for the applicant listed above. I understand that approval will result in a card
being issued to the applicant. I have read and agree to the terms and conditions, and I acknowledge and agree toliability for the conduct of the pass holder.
I have read and agree to the terms and conditions.
I have attended and understood the Club orientation session.
Sponsor Member
Orientation date:

Start date:

Name:

Membership no:

Cell:
Signature:

Date:

Director’s signature:membership@tac-club.org•www.tokyoamericanclub.org

Domestic Helper Terms and Conditions
A. CRITERIA
1. Domestic Helper Pass holders must be 18 years of age or older, with appropriate visa (if required), have an understandingof English and be physically capable of supervising small children.
2. Domestic Helper Pass holders will be familiar with all Club rules and agree to the conditions of use, including access,charging, loitering, identification, supervision of children.
3. Domestic Helper Passes require advance registration (name, date of birth, nationality, relationship to Member, if any, andnames of children to be escorted) at the Membership Office.
4. Domestic Helper Pass applicants must have their identification verified at the Membership Office and submit to an
explanation of the rules and conditions to complete registration.
5. One-Day Helper Passes must be returned to Member Services or the Membership Office when leaving the Club. Failure
to return a one-day pass shall result in a ¥5,000 penalty to the Member.
B. ACCESS
1. Family side of the Club only, as detailed in points 2, 3, 4 and 5 below, and with the children for which they are responsible.
2. B1: The Cellar, Activity rooms and casual play area. The waiting areas are the casual play area and the seats outside theactivity rooms.
3. First floor: all Member areas, except Mothers’ Room (breast-feeding room).
4. Second floor: Library, activity areas where their charges are participating in programs and changing rooms. The waiting
area is the seats outside the Gymnasium.
5. Sky Pool: common areas, changing rooms, Splash!, Sky Pool. The waiting area is the Sky Pool deck. Pass holders are notpermitted to swim without payment of a guest fee.
C. SUPERVISION
1. Domestic Helper Pass holders are responsible only for children as designated in the application.
2. Domestic Helper Pass holders are responsible for the conduct of the children in their charge.
3. Domestic Helper Pass holders must remain with the children at all times, unless in a specified waiting area when thechildren are engaged in supervised activities.
4. Some specific youth programs may require the participation of a parent. Members should confirm prior to registration.
D. FOOD AND DRINKS
1. Domestic Helper Pass holders are entitled to food and drinks (excluding alcohol) only from family dining restaurants.
2. As stated in the General Rules, food and drinks may not be brought to the Club for consumption.
E. FEES
1. Domestic helper monthly fee: ¥6,000
2. One-Day Helper Pass: ¥1,000
3. Penalty fee for failure to return pass: ¥5,000

membership@tac-club.org•www.tokyoamericanclub.org