Name: Fitness Center Memberships - Alumni Gym
Start: 2102-06-20T23:46:00.000Z
End: 2102-12-31T08:00:00.000Z
Location: Clarkson University Athletics

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Fitness Center Memberships - Alumni Gym

Participants First Name

Participants Last Name

Participants Birth Date

Participant Mailing Address

Participants Phone Number

Participants Email

In case of emergency, please contact:

Relationship to emergency contact

Emergency Contact Phone #

Names, DOB and Relationship to cardholder of those receiving cards in a Family Membership(***Family Membership Information: If applying for family membership, please provide information for immediate family members(spouse, children up to the age of 21(who will be on this membership). Children under 16 MUST be accompanied by a family member.

Family Membership - Name, DOB, Relationship to cardholder

Has your doctor ever said you had a heart condition?

Do you feel pain in your head/back/chest when you engage in physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

In the past month, have you had chest pain when not engaged in physical activity?

Do you have any bone/joint problem that can be made worse by physical activity?

Are you currently taking any medications? If Yes, please specify

The undersigned, by toggling on the box above, signing, and dating this Assumption of Risk and Release of Liability acknowledges that I/We assume all risks in any way connected with or related to physical exercise and herby waive any and all claims which I may have arising out personal injury, death, theft or destruction to personal property and release Clarkson University, its agents and employees harmless from any liability whatsoever related to my use of the Clarkson University athletic and recreational facilities including reasonable attorney''s fees. For any membership including privileges for family use of these facilities, all the representation of this Waiver and Release apply with equal force to all members of the family.

The undersigned, by toggling on the box above

The undersigned, by toggling on the box above, signing, and dating this Assumption of Risk and Release of Liability acknowledges that

I/We acknowledge that I/We have answered all health related questions correctly to the full extent of my knowledge. 

*If I/We answered YES to one or more of the above questions about my health, I acknowledge that I/We may need written permission from a physician prior to participating in physical exercise at the Recreation Facility located on Clarkson University Campus. I will tell my doctor about the Health Questions asked that I/We answered YES to, and will bring a release form signed by a doctor.

*If I/We answered NO to ALL questions of the above questions about my health, it signifies that I/We are permitted to engage in physical fitness activities at the Recreation Facility located on Clarkson University Campus. The fact that I/We answered NO does not guarantee I/We have a normal response to exercise. I/We will begin slowly and gradually progress. If I/We experience any abnormality, I/We will stop immediately.

By signing this Waiver & Release Form, I agree that I understand the risks of exercise, have no physical limitation that would be made worse by exercise. I have fully read and agree to terms and conditions.

I/We acknowledge that I/We have answered all 

Individual - Monthly

Individual - 6 Months

Individual - Yearly

Family - 6 Months

Family - Yearly

Alumni - 6 Month

Alumni - Yearly

Alumni Family - 6 Month

Alumni Family - Yearly

Adult Child of Employee

CU Student Spouse - 6 Month

CU Student Spouse - Yearly

Non - CU Student - 6 Month

Non - CU Student - Yearly

Senior(62+) - 6 Month

Senior(62+) - Yearly

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Fitness Center Memberships - Alumni Gym

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