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How Can You Join?
Student Membership Consent Form
& Liability Waiver
I. Definitions:
A. Underground Fitness - a student run organization dedicated to introducing high school students to a fitness oriented
lifestyle.
B. Undeground Fitness Center - 1800 square feet of space in MA.
C. Board of Directors (B.O.D.) - A 10 member steering committee in charge of the overall direction and management of daily
operations. B.O.D. members are elected annually for a one year term beginning in January.
II. Membership Contact Information:
Participants Name ____________________________________ Birthdate _______________
Address____________________________________________________ZIP_______________
School _________________________________________Home Phone __________________
E-Mail _______________________________________________________________________
Parent/Guardian ___________________________________Relationship _______________
Work Phone________________ Home Phone _________________ Pager _______________
Parent/Guardian ___________________________________Relationship _______________
Work Phone________________ Home Phone _________________ Pager _______________
Emergency Contact Name _______________________________ Phone ________________
III. Medical Information
Doctors Name __________________________Phone________________________________
Insurance Name _____________________________________ Policy # _________________
Allergies/Medications ______________________________________________________________________________
IV. Teen Membership Code of Conduct
The Underground Fitness Center of Marthas Vineyard requests all Teen Members to follow the Facility Guidelines in the Member
Guide as well as our Basic Respect Policy
A. Basic Respect Policy:
TO RESPECT YOURSELF,
TO RESPECT THOSE AROUND YOU,
AND TO RESPECT THE ENVIRONMENT YOU ARE IN.
B. Facility Guidelines:
Membership is based upon adherance to all of the following rules. Please respect the Underground Fitness Center by:
-Using language appropriate for the site of this facility
-Having respect for the space of others
-Refraining from the use of alcohol, tobacco, or illegal drug use
-Adhering to suggested safe training practices and methods
-Treating everyone associated with the Underground Fitness Center (fellow members, Board of Directors [BOD] members,
and personal trainers) with respect
-Treating the equipment and space as if it were your own
-Adhering to posted rules regarding equipment use
-Adhering to the food/ beverage rule (ie. Water is the only food or beverage allowed in the Undeground Fitness Facility
*** Gum would be considered a type of food
*I understand that I will be held responsible for any damages to the equipment or the facility that I have caused
Teen Member Signature __________________________________ Date: ______________
V. Parent / Guardian Waiver and Release of Liability
A. As the Parent/Guardian of the above Teen Member, I understand that the UFC is not providing childcare, and that I must
be involved in the development of adolescence. Teen Membership requires that my child be responsible, courteous and somewhat
independent. I also give permission to the UFC to transport my child in UFC vehicles for field trips and events.
B. Recreation and fitness services: Waiver and release of liability
In agreeing to allow my son/daughter to participate in recreation and fitness activities at UFC, I agree as follows:
My son/daughter fully understands and acknowledges that recreational and fitness activities have (a) inherent risks, dangers,
and hazards and such exists in his/her use of any equipment and his/her participation in these activities; (b) his/her participation
in such activities and/or use of such equipment may result in injury or illness including, but not limited to bodily injury,
disease, strains, fractures, partial and/or total paralysis, death or other ailments that, could cause serious disability;
(c) these risks and dangers may be caused by the negligence of the representatives, employees, or volunteers of UFC, the negligence
of the participants, the negligence of others, accidents, breaches of contract, or other causes; (d) by his/her participation
in these activities and for use of equipment, my son/daughter hereby assumes all risks and dangers and all responsibility
for any losses and/or damages whether caused in whole or in part by the negligence or the conduct of the representatives,
employees, or volunteers of UFC, or by any other person.
I, on behalf of my son/daughter, hereby voluntarily agree to release, waive, discharge, hold harmless, defend, and indemnify
UFC and its representatives, employees, and volunteers from any and all claims, actions or losses for bodily injury, property
damage, wrongful death, loss of services or otherwise which may arise out of my use of any equipment or participation in these
activities. I specifically understand that I am releasing, discharging, and waiving any claims or actions that he/she may
have presently or in the future for the negligent acts or other conduct by the representatives, employees, and volunteers
of UFC.
I HAVE READ THE ABOVE WAIVER AND RELEASE AND BY SIGNING IT AGREE. IT IS MY INTENTION TO EXEMPT AND RELIEVE UFC FROM LIABILITY
FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH CAUSED BY NEGLIGENCE OR ANY OTHER CAUSE.
Parent/Guardian Signature ________________________________Date ______________
Parent/Guardian Signature _______________________________Date _______________
VI. Underground Fitness Center Staff
We pledge to provide a wholesome environment for teens at the UFC and will encourage them in areas of personal growth, character
development and healthy lifestyles.
Teen Membership Staff ___________________________________Date _______________
Benefits of Joining
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