Common Contracts
1 similar Waiver and Agreement contracts
Membership Dues: Resident/Non-Resident - $12.00Waiver and Agreement • September 21st, 2021
MEMBERSHIP FORM - PAGE 1 15 Fairport Harbor Senior Citizens CenterMembership Form for the Year 2022 ❑ New Member❑ Renewal Personal Information Name: (First) (M.) (Last) Address: City, State, Zip: Telephone: Cell Phone: Birthday Date: Anniversary Date: Email Address: Spouse/Partner: Emergency Contact Name: Relationship: Address: City, State, Zip: Telephone: Cell Phone: Dues Payment Check No. & Amount: Cash Amount: $ Your Interests: Any Special Needs: Participation Waiver and Agreement Please read and sign1. I, _, a participant in activities, programs, and trips sponsored by Fairport Senior Center, do hereby acknowledge that I am voluntarily participating. I recognize that in any activity program or trip, there are certain risks of injury to myself. I declare that my health and physical condition is adequate to meet the physical requirements of activities, programs, and trips in which I participate.2. I agree to hold the Fairport Senior Center, their respective agents
