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Baierl Center |
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North Allegheny Fitness Center
Membership Membership
Agreement Last
Name _________________________ First _____________________
MI _______________ Address
_______________________________________________________________________ City
____________________________ State ___________________ Zip
Code ______________ Social
Security Number _________________________ Date of Birth
______________________ Home
Phone Number (____)________________ Business
Phone (____)____________________ Today’s
Date _________________________ Expiration Date
____________________________ Membership
Type _____________________________ Member Number
___________________ Contact
Person in Case of Emergency
_______________________________________________ Telephone
Number of Contact Person (____)__________________________________________ Term
_____________________________________ I,
_____________________________ , hereby understand and
acknowledge upon payment of the required fee that the North
Allegheny School District (hereinafter “District”)
hereby grants me permission
to use and enjoy the Baierl Center facilities,
including all cardiovascular equipment, weight lifting and
exercise equipment now and hereafter available for use
during the terms of this agreement. I
acknowledge that I have read, understand and agree to the
rules and conditions for the use of the Baierl Center.
Further that the terms and conditions of this
agreement and the rules and regulations are subject to
change at the sole discretion of the District, with or
without notice. I
understand and agree that the Baierl Center’s days and
hours of operation are within the sole discretion of the
District and may be changed at any time and for any reason
with or without notice. I
understand and agree that the District makes no guarantee
either expressed or implied as to the type, style or number
of pieces of equipment available for my use and the District
retains the right to restrict the use of such equipment at
any time and for any reason, with or without notice. I
understand and agree that the District, in its sole
discretion, determines that I have violated the rules,
policies or regulations or have engaged in any form of
illegal or undesirable behavior, the District shall have the
right to revoke my use of the facility.
Further, in the event I should either intentionally
or negligently damage any equipment or the facility in
manner, I agree to reimburse the District for the cost of
repair of the equipment or facility. I
understand, acknowledge and agree that all exercise and
other activities shall be undertaken by me solely at my own
risk and that the District, its agents, employees, board
members and officials shall not be liable to me for any
claims, demands, injuries, damages, suit, actions or causes
of action whatsoever, including pain and suffering to my
person or property, arising out of or in connection with my
use of any and all the exercise facilities and services of
the Baierl Center. I
understand and agree that the District has no obligation on
instructing me as to the use of any equipment or exercise
programs. Further,
I understand and agree I am fully responsible for the
operation of all equipment and for my own exercise program. I
hereby release and forever discharge the North Allegheny
School District, its agents, employees, board members, and
officials from any and all claims, demands, rights, and
causes of action whatsoever kind and nature, arising from,
and by any reason of, and bodily and personal injuries or
damages to person or property which I sustain as a result of
or in connection with my use of the Baierl Center
facilities. Member’s
Full Signature
_________________________________________________________
Signature
of Parent or Guardian
____________________________________________________ (if
under 18 years of age) North
Allegheny Athletic Director
__________________________________________________ Total
Amount of Dues _____________________ Amount Paid
_____________Date ___/___/__
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