Membership Application & Agreement

 

First Name: _______________________________________ Last Name: ______________________________________________

Address: ________________________________________________________________________City: _______________________

State: ________________ Zip: ______________ E-mail Address: _____________________________________________________

Phone Number: ____________________ Type of Membership: _____________________________________________________

Employer: _____________________ Date of Birth: ____________ Gender ______ Contract Start Date: _______________

This agreement constitutes the entire and exclusive agreement between the signing parties on the contract start date. All membership fees

have been reviewed and agreed to. Upon payment membership privileges are granted to the additional following individual(s).

Name                                                                           Birth Date                                Gender

1. ______________________________         ____________________             ___________ 

2. ______________________________         ____________________             ___________ 

3. ______________________________         ____________________             ___________

4. ______________________________         ___________________                ___________

5. ______________________________         ____________________             ___________ 

6. ______________________________         ____________________             ___________

Payment Options: (please select your payment option)

______ PAID-IN-FULL MEMBERSHIP

______ MONTHLY PAYMENT PLAN

The monthly payment plan for this type of membership is: $_______ due by the 30th of each month

Membership Dues: $__________

Discount Given $__________ Reason for discount: ____________________________________

Total Payment Received: $__________

Waiver and Release Agreement

The Veterans Park Community Center is committed to conducting its recreation programs and activities in a safe manner and holds the safety of participants in a high regard. The Veterans Park Community Center continually strives to reduce such risks, and insists that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However, participants and parents/guardians of minors registering for this program/activity must recognize that there is an inherent risk of injury when choosing to participate in recreational activities. You are solely responsible for determining if you or spouse, or your minor child/ward are physically fit and/or skilled for the activities contemplated by this agreement. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered an illness, injury or impairment, to consult a physician before undertaking any physical activity. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any recreational activity/program. Understandably, not all hazards and dangers can be foreseen. Participants must understand that certain risks, dangers and injuries due to acts of God, inclement weather, slipping, falling, equipment failure, premise defects and all other circumstances inherent to recreational activities/programs exists. In this regard, it must be recognized that it is impossible for the Veterans Park Community Center to guarantee absolute safety.

Please read this form carefully and be aware that in signing up and participating in this facility’s programs/activity, you will be assuming the risk and legal liability and waiving and releasing all claims for injuries, damages or loss which you/or and your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this facility’s program/activity. I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages, or loss, regardless of severity, that my minor child/ward or I may sustain as a result of said participation. I further agree to waiver and relinquish all claims my minor child/ward or I may have (or accrue to me or my child/ward) as a result of participating in this program/activity against the Veterans Park Community Center, City Cabot and State of Arkansas including its officials, agents, volunteers and employees [hereinafter collectively referred to as the Veterans Park Community Center].

I do hereby fully release and offer discharge the Veterans Park Community Center from any and all claims for injuries, damages, or loss that my minor child/ward or I may have or which may accrue to me or my minor child/ward arising out of, connected with, or any way associated with this program/activity. If registering online or via fax, your online or facsimile signature shall substitute for and have the same legal effect as the original form signature. I have read this release and waiver of liability, assumption of the risk and indemnity agreement, fully understand its terms, understand that I have freely and voluntarily without any inducement, assurance, or guarantee being made to me and intend my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.

Membership Cancellation / Refund Policy

If an individual is unable to continue their membership by reason of death, permanent disability, or residence is permanently relocated outside of our service area, the member will be relieved from the obligations of this contract. Legitimate verification of the circumstance and cancellation must be presented in writing. If the member has prepaid, the pro-rated amount will be refunded. All refunds are subject to a $25.00 service charge. Downgrading a membership is not allowed.

The Community Center reserves the right at any time to terminate the membership of any Member for failure to comply with any of the rules and regulations adopted by The Community Center governing board. The terminated member will be required to return his/her membership card to The Community Center. The terminated member will remain liable for the remainder of their contract period. Any member who is thirty (30) days late with payment will be subject to a 10% fee of the balance of the account each month. A $25 service charge is accessed for a check that is returned insufficient.

Membership Renewal Policy

Memberships may be renewed at the current membership rate. Memberships are automatically renewed if payment is received after the expiration of a previous membership. All other memberships must be renewed by the member.

Membership Agreement

The classification of Members, the amount of dues payable be members of each class, the amount of fees, the suspension and expulsion of Members, and all other matters affecting and relating to the Members or Membership shall be under complete control of the Veterans Park Community Center. Membership rates are subject to change without notification. All memberships are monthly, three (3) month, semi-annual or annual memberships. A $25 service charge is accessed for a check that is returned as insufficient.

It shall be policy of The Community Center to accept applications for membership from an individual, couple, or family of good character with out regard to race, color, creed, sex, national origin, or physical disabilities.

The obligation to pay dues is not dependent on the availability of The Community Center’s facilities. Tournaments, repairs and (or) maintenance of the facilities may make it necessary for The Community Center to restrict use of one or more facilities or temporarily close The Community Center that will not reduce or suspend the Members’ obligation for payment of dues.

Additional Membership Agreement Terms

CHECKING IN: No member will be admitted to The Community Center without checking in or registering at the front desk of The Community Center. An adult must accompany children twelve (12) and under at all times, unless the child is enrolled in a program. Children under the age of thirteen (13) will not be admitted to The Community Center, unless an adult accompanies them or unless the child is enrolled into a program.

GUEST POLICY: All non-members must register and guest fees must be paid before entering.

VALUABLES AND PERSONAL PROPERTY: Members are asked not to bring valuables into The Community Center or on its premises. Community Center management and employees are not reliable for storage, safekeeping, or damage of member’s property. The Community Center is not responsible for any lost or stolen goods.

DAMAGES: The cost to repair damage to The Community Center’s property by a member, member’s guest and/or dependant children shall be paid by the undersigned.

SUSPENSION OF MEMBERSHIP: The Community Center has the right to suspend any membership due to non-payment of dues, for violation of rules or policies, or for behavior deemed inappropriate for the facility.

FITNESS EQUIPMENT: You must be at least sixteen (16) years of age to use the fitness equipment located in the fitness room around the walking track.

For a complete list of all membership rules and policies, please contact the front desk of The Community Center.

I hereby agree to accept the terms and conditions of this membership application and agreement. The undersigned shall receive the membership rights and privileges and agrees to abide by all rules and policies of The Community Center, which are subject to change and which, in the opinion of The Community Center management, are deemed necessary and reasonable for the best interest of its members and The Community Center.

 

 

____________________________________________________         ____________________________________________

Primary Member Signature                                          Date                               Member Assistant Signature                     Date