2020 Social Club Membership Form

Parks and Recreation

June 17, 2020

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CONTACT INFORMATION
Legal Name * Required
First Last
Nick Name
If you prefer to be called something other than your legal name place name here.
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email * Required
Phone * Required
HEALTH INFORMATION
Date of Birth - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Allergies, Injuries, Medications, Illnesses * Required
Please state any medications, allergies or injuries we should be aware of. If none place NA
EMERGENCY CONTACT INFORMATION
Name * Required
First Last
Phone * Required
Waiver of Liability, Assumption of Risk, and Indemnity Agreement
Participation Waiver: In consideration of the opportunity to participate in any of the activities ("Activities"), provided by the City of Madeira Beach, I, for myself, my family, my children, my heirs, my estate, my personal representatives and assigns (hereinafter collectively referred to as "Participant:), do hereby completely and fully release, waive, covenant not to sue, and forever discharge the City of Madeira Beach, its elected and appointed officials, and its officers, employees and agents (collectively hereinafter "the City"), from all liability, responsibility, actions, damage, costs and claims for personal injury, accidents, illnesses, death, and property damage and loss (hereinafter collectively referred to as "Injuries and Loss"), arising from, related to, or in any way connected to participation in any of the Activities.
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Documents and forms

2020 Social Club Membership Form

CONTACT INFORMATION

HEALTH INFORMATION

EMERGENCY CONTACT INFORMATION

Waiver of Liability, Assumption of Risk, and Indemnity Agreement