Signature of Participant. Check one: 18 years of age or older Under 18 years of age (Parent/Guardian consent required) Print Name: Address: City: State: Zip: Phone: Date: Birth Date Age Parents or Guardian’s Additional Indemnification (Must be completed for participants under the age of 18) In consideration of (print minor’s name)(“Minor”) being permitted by NPRCC to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless NPRCC from any and all Claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor. Signature of Parent or Guardian: Date:
Signature of Participant. Date PHOTO RELEASE I hereby give my permission to the City of Riverside, the Spanish Town Heritage Foundation and the Riverside Tamale Festival to photograph me / to photograph my child/children. I , hereby grant the City of Riverside, the Spanish Town Heritage Foundation and the Riverside Tamale Festival an irrevocable right and permission, in connection with the photographs/videos taken of me and my child, or in which I or my child may be included with others for use in any manner consistent with the law. I also grant the City of Riverside, the Spanish Town Heritage Foundation and the Riverside Tamale Festival all legal rights associated with the use of reuse of said photographs, in whole or in part, either by themselves or in conjunction with other photographs in any medium and for any purposes whatsoever, including all promotional and advertising uses as well as, using my name in connection therewith if it is so desired, without compensation. I understand that all photographs taken by the City of Riverside, Spanish Town Heritage Foundation, and the Riverside Tamale Festival or their employees, agents or assigns, become the sole property of the City of Riverside, the Spanish Town Heritage Foundation, and the Riverside Tamale Festival. I hereby release and discharge the City of Riverside, the Spanish Town Heritage Foundation, and the Riverside Tamale Festival its assigns, licensees and legal representatives from any and all claims, actions and demands arising out of, or in connection with, the use of said Photographs including without limitations, any and all claims for invasion of privacy and libel. I have read the above authorization, release and agreement prior to its execution, and I am fully familiar with the contents thereof. This release shall be binding upon me and my heirs, legal representatives and assigns. I understand that the Photographs may be published in City, the Spanish Town Heritage Foundation, or Riverside Tamale Festival print publications and /or used in promotional displays. The photographs may be used on website/social media but no child’s name will be published on the internet. I understand that I will not be compensated for the use of the Photographs and also hereby voluntarily waive, release and relinquish any right to be compensated for the use of the Photograph. Please be advised that all participants involved in any programs and/or events are subject to being photographed. SIGNATURE OF PARTICIPANT: Date: Parent/Guardian: I d...
Signature of Participant. Minors I, , the parent or legal guardian of , consent to my child participating in the Program and agree, in consideration of my child being permitted to participate in the Program, to be bound by the terms of this Release and Assumption of Risk and hereby indemnify, hold harmless and release The Fitness Center employees, volunteers and agents, in the same manner and with the same force and effect as set forth in section 3 above with regard to my child participating in the Program. Signature of Parent or Guardian: , Date: INDIVIDUAL The Fitness Center Membership Rates • Monthly $35.00 EFT (electronic funds transfer, one year commitment) • 3-Months $90.00 • Semi-Annual $170.00 • Annual $320.00 INDIVIDUAL W/SPOUSE/PARTNER • Monthly $65.00 EFT (electronic funds transfer, one year commitment) • 3-Months $170.00 • Semi-Annual $330.00 • Annual $575.00 FAMILY (up to 4 within household) • Monthly $100.00 EFT (electronic funds transfer, one year commitment) • 3-Months $250.00 • Semi-Annual $475.00 • Annual $875.00 FAMILY (5+ people within household) • Monthly $150.00 (electronic funds transfer, one year commitment) • 3-Months $390.00 • Semi-annual $720.00 • Annual $1320.00 Short-term Monthly $45 for one month (individual only) Punch-card Plan $60 for 6 visits + $5 FOB fee One Day Pass $10 (weekdays from 8am-5pm only) Senior Discount Individual & member plus spouse plan over 65 5% off Personal Training • Per session $40.00 • Pre-pay 3 sessions $110.00 • Pre-pay 6 sessions $220.00 Transitions (after physical therapy) Program • 8 sessions group setting $80.00
Signature of Participant. (If participant is under 18 years of age, a parent’s/guardian’s signature is required.) / / Date
Signature of Participant. The Participant named above executed this document in my presence.
Signature of Participant. Date If from same immediate family, additional ADULTS may acknowledge this Agreement and sign below (this Agreement is not to be signed by participants who are 17 years of age or younger): Name of Participant (Please Print) Signature of Participant Name of Participant (Please Print) Signature of Participant Name of Participant (Please Print) Signature of Participant
Signature of Participant. Print name of Participant If under 18 years of age, my parent or guardian must sign below. I represent that I am the parent or guardian of the above-named Participant to whom this Release applies and that I have the legal authority to execute this Release. For good and valuable consideration received by me, I approve the foregoing and warrant and agree that we both shall be bound by the provisions of this Release. Signature of Parent/Guardian Print Name of Parent / Guardian Signature of Parent/Guardian Print Name of Parent / Guardian
Signature of Participant. Date: (If participant is under 18 years of age, a Parent’s/Guardian’s signature is required.) Signature of Parent/Guardian: Free Program. Date:
Signature of Participant. If participant is a minor under the age of 16 (“Child”), signature of parent or responsible adult is required below: In consideration of the Child being permitted to participate in the activity, I accept and agree to the full contents of this agreement. I certify that I have the authority to sign on behalf of the Child and to make decisions for the Child regarding this activity. I also agree to RELEASE, HOLD HARMLESS, INDEMNIFY, AND DEFEND the Released Parties from all liabilities and claims that arise in any way from any injury, loss, or harm that occurs to the Child during the activity or in any way related to the activity, including any claim of the minor and any claim from the negligence of the Released Parties. Relationship: Print Name of Parent/Responsible Adult
Signature of Participant acknowledge that the above list is not inclusive of all possible risks associated with the work and that the list in no way limits the extent or reach of this release and covenant not to sue. Agreement to Abide by Rules of Safety (Participant) Please Print Name Clearly Signature of Parent or Guardian if Participant under 19 years of Age I hereby acknowledge and agree that I have a personal responsibility to follow safety rules and procedures established for the activity or by the supervisor(s). Further, I agree to report to the supervisor(s) at any point at which I question my knowledge of these rules or procedures or my ability to participate in any aspect of the activity.
